College and UniversityConcussionResearch

Cal State Fullerton researcher helps students return to class after concussions


Article reposted from The Orange County Register

Meaghan Beaudoin just could not figure out what was going on in her head.

Sure, she was once knocked unconscious while playing soccer at Cal Poly during the early 2000s. But a hospital told her she was fine because there were no blood clots in her brain.

But she was failing classes. She could not quite grasp what she was learning.

A couple of years into Cal Poly, Beaudoin got an answer: Second-impact syndrome from the concussions she got in high school.

“I don’t want my students to go through what I went through,” said Beaudoin, now the athletic trainer at Sage Hill School in Newport Beach.

Concussion and its symptoms can be hard to spot, but its impacts are far-reaching, especially for student-athletes. Furthermore, the athletes cannot fully dedicate themselves to rest or rehabilitation. They have classes to go and homework to finish.

Tricia Kasamatsu, a Cal State Fullerton kinesiology professor who joined the university in 2015, has been researching how high schools support student-athletes after a concussion.

She said that until recently, schools and researchers had neglected much of the so-called “return-to-learn” aspect of concussions.

“It’s still a gray area,” she said.

Kasamatsu had been working as a high school athletic trainer and biology teacher in El Modena High School in Orange, after getting her bachelor’s degree in kinesiology and her master’s teaching degree at Chapman University.

In 2010, a football player told her that he was struggling in his classes.

People around him didn’t know what to do. They wanted to help, but some of them wondered whether he was faking his injuries to slack off.

This experience motivated Kasamatsu to research how schools can best guide concussed student-athletes’ return to class. For her doctorate in education at Chapman, Kasamatsu wrote a dissertation on the topic.

She said many concussed students experience similar issues as students with learning disabilities.

The concussed students get headaches when they try to focus. They have a harder time remembering what they had learned. They face emotional distress, from their concussions and also often from the fact that they can’t play the sports they love.

“(Concussion) is a collection of emotional, physical and psychological stress,” she said.

The California Interscholastic Federation, or CIF, has a “return to learn” protocol, which recommends teachers give recovering students breaks and less homework.

“But the communication is left up to each physician or school,” Kasamatsu said.

Each person reacts differently to concussions, which Kasamatsu said further challenges schools. For instance, some students get a headache from projectors emitting bright lights. Others may struggle to read small prints on whiteboards.

Some students can recover in days. Others take months.

Kasamatsu is not interested in setting a rigid rule. Instead, she said she wants to help schools create a supportive infrastructure.

Kasamatsu works with athletic trainers across Southern California, updating them on the latest research and studying how they deal with concussed students.

“She is kind of my go-to,” Beaudoin said.

Chase Paulson, the head athletic trainer at Diamond Bar High School, said he encouraged Kasamatsu to study his school’s protocol and its impact on concussed students.

“I have a responsibility to make the profession better,” Paulson said.

Kasamatsu said her next research will examine how a support team — which includes, among others, teachers, athletic trainers, parents, nurses and academic counselors — functions in schools.

Local high school’s “return to learn” policy

Sage Hill no longer plays 11-man football.

Beaudoin said only about 20 players are on the school’s eight-man football team, which she attributed partially to a shift in how parents view football and concussion.

Still, Beaudoin said seven to ten students come to her every year with a head injury.

The school has a concussion management team that includes athletic trainers like Beaudoin, a learning specialist, an academic counselor and a concussed student’s parents.

The team works with the student’s physician and teachers to find the right learning accommodation, which can range from giving more time to complete homework to having a dedicated notetaker.

At the beginning of school year, she reminds teachers of the school’s “return to learn” policy. The teachers have become more understanding of the students’ needs, Beaudoin said.

But Beaudoin and Paulson said many challenges remain.

Diamond Bar High, like Sage Hill, has a concussion management team. The team checks student’s symptoms daily and communicates with the student’s physicians and teachers.

However, Paulson recalled a teacher calling him, asking if a student should get an accommodation for a test. Paulson said yes.

“I didn’t believe (the student),” Paulson recalled the teacher saying.

He added some students’ parents, because of language or cultural differences, can’t quite grasp concussion.

“That has been an ultimate challenge,” he said.

But Paulson said the teachers and parents have begun to understand his protocol.

“I can always be more conservative, but never more aggressive,” he said. “I have to make sure the kid has a livelihood.”


Athletic Trainers Lead the Concussion Battle, Says Neurologist


Article reposted from EIN Newsdesk
Author:  EIN Newsdesk

Fighting the war against sport concussions are unsung heroes making life and death decisions every day in the trenches. I’m glad March gives us a chance to recognize the National Athletic Trainers Month, because athletic trainers often get taken for granted, but they are always appreciated.

Athletic trainers carry the torch for the medical world, parents, coaches and athletes, into concussion battle every time teams engage in sports. Their role in concussion management is mission critical to preserving the health — and future — of our athletes.

Here’s why — They C.A.R.E.:

C ulture —
Sports breeds a “toughness” culture that easily overlooks so-called “dings.” Literally, everyone plays a role. We all can improve our “spotting” and recognize concussion symptoms including players, coaches, referees, fans, school administrators, and even politicians. But nobody plays a more important role than athletic trainers. They face the culture daily, and sit the players down when they have to, despite the conflicting motivations of the player, coach and teammate.

A pplication —
Athletic trainers apply the latest in sports management that they possibly can afford. Through their unbiased lens, they provide the first-line of defense with concussion detection and overseeing the consequential recovery protocols. Most people don’t realize how much work is involved with this process which begins during the pre-season with neuro-cognitive baseline and balance testing. The data collected provide baseline measurements which help medical personnel with authorizing the return-to-play clearance.

R esearch —
Concussions continue to be one of the hottest topics in neuroscience. Athletic trainers are the gateway to accessing data that will define the future of concussion management. The challenge athletic trainers have is managing data. Athletic trainers have the herculean task of managing all the aspects for all the athletes’ health. Most schools have one or two certified athletic trainers serving more than 100 or more athletes.

E ducation —
Athletic trainers are tasked with knowing and applying the latest in concussion management including concussion education, baseline measurement, sideline assessment, reporting and overseeing recovery care. With all these pieces, athletic trainers must be continually be educated in the nuances of concussion care.

Additionally, athletic trainers are required to have bachelor’s degrees with studies in nutrition, exercise physiology, kinesiology, and biomechanics. Most programs want athletic trainers with master’s degrees, accreditation, or certification in various athletic training education.

The regarded National Athletic Training Association (NATA) defines athletic trainers as healthcare professionals who recognize, prevent, and rehabilitate injuries that result from playing sports or other physical activities. They may be part of a complete health care team and work under a physician’s supervision. Athletic trainers provide medical and allied health care services to individual athletes or entire sports teams. Elementary or high schools, colleges, and professional sports organizations, as well as medical centers may employ them.

When an athletic trainer, who may be responsible for the health of hundreds of athletes at a time, has multiple concussions to manage, varying levels of severity, and recovery timelines, just managing concussion injuries alone can be a major juggling act.

The truth is athletic trainers deserve a hug of appreciation. Thank you for helping preserve the athletes and the games we love.

ConcussionSecondary School

Indiana Athletic Trainer sees both sides of concussion issue


Article reposted from

As certified athletic trainers with three kids in sports who have all experienced concussions, Chesterton’s Bernie and Kim Stento have a dual perspective on a subject that’s become much more prevalent at each level of play.

“Every week, you hear something. Bo Jackson or some former player is coming out saying they’re not going to let their kids play (football), knowing what they know now,” Bernie Stento said. “It’s something Kim and I have talked about quite often. We understand both sides. We deal with both sides. We talk to parents, people who have a fear and it’s not just football. There’s a risk in most sports.”

Stento’s response? Take it seriously, but don’t press the panic button.

“Football is not this horrible, evil thing,” he said. “We feel there’s a great benefit to playing. You hear really scary things in the news, but there are thousands who have recovered when it’s handled properly. You never hear about all the kids who continue their careers and go on to become doctors or lawyers. Despite all the negative things, you shouldn’t take one person’s perspective and make it the rule for everybody in the sport.”

Much of the discussion has centered around Chronic Traumatic Encephalopathy, the cumulative effects of hits to the head over the course of many years. While this by and large applies to the small percentage of those who have gone on to play beyond high school, it’s raised concerns about the safety of youth football. The Stentos’ youngest, Luke, plays Pop Warner and wrestles among a myriad of sports. Of the kids’ three concussions, two were not sustained in football.

“Luke loves football,” Stento said. “He’s good at it. He’s into it. It would be hard for us to say you can’t play. We’ve talked to him and his coaches about proper (tackling) technique, using your shoulder, minimizing (head) contact, to make sure he’s protected. There’s talk about using more padding. There are a lot of avenues to keep the sport safer at the younger levels.”

In high school, there’s been a marked reduction in the amount of contact allowed before and during the season. All coaches are required to be trained on the subject of concussions. All 50 states have concussion safety laws. Ivy League football coaches voted this spring to eliminate all full-contact hitting from regular-season practices, the most significant action taken to address brain trauma in the sport.

“We’re in a transition period where we’re getting out of the old way of doing things,” Stento said.

At Chesterton, any athlete, in football or other sports who sustains a head injury has to go through a four-step process before they are allowed to return to activity. Stento said no Chesterton student who has gone through it this school year has had residual effects.

“How we handle it now is so much better,” he said. “We’ve gotten out of the old way of doing things. There’s better awareness. Checks and balances are in place to ensure we’re doing things appropriately, in the best interests of the kids, and we’re going to learn more as we go on.”

While Stento said he hasn’t had a lot of parents seek him out, he wants anyone with questions or concerns to know his door is open.

“Learn the facts. Get educated,” he said. “There are inherent risks involved but understand we do take care of your kids. Ultimately, the family has to weigh things personally and make that decision if they want their child to play.”

As to the future of football at the various levels?

“I don’t have a crystal ball to say I know what’s going to go on in the next 15 years,” Stento said. “I don’t see it football going away any time in the immediate future.”

ConcussionPreventionSecondary School

Kentucky Athletic Trainer Takes Care of Head Injuries


Article reposted from WPSD Local6
Author: Amanda Roberts & Jason Tomason

Football season is here, the games are about to start and trainers say so are the injuries.

The American Academy of Pediatrics says concussions are up 200 percent among teens in the past decade. That’s one of the reasons Mercy Regional EMS hosted a seminar for trainers and first responders on removing helmets and shoulder pads from players with head injuries. Responders say it could make the difference between recovery and being bound to a wheel chair.

Paducah Tilghman High School trainer Jason Crivello says he knows his student athletes. But, he says, he never knows how they’ll need his time or attention. That’s why Crivello says he needs to know the best way to work with emergency responders if one of the players falls on the field with a head injury.

“You’re with these kids every day, and that’s the difference between athletic trainers at the school every day versus the paramedics,” Crivello says.

Mercy Regional EMS Capt. Wes Rhodes says he knows how badly a player can get hurt even with helmets and pads. If the equipment isn’t handled correctly, Rhodes says a player can walk away with worse injuries.

“When I see a bad hit on the field, the first thing that comes to my mind is being in EMS,” Rhodes says.

Every accident calls for its own protocol. Sometimes emergency responders will remove pads and helmets, other times they won’t.

Crivello says they do their best to keep their student athletes safe and healthy, but they also prepare for the worst.

Gridiron Glory coverage starts this Friday on Local 6.


ConcussionPreventionSecondary School

Indianapolis Athletic Trainer Protecting Against Concussions with Technology


Article reposted from IndyStar
Author: Kyle Neddenreip

When the Brebeuf Jesuit football team has its first contact practice on Aug. 4, it will be business as usual for athletic trainer Patrick Miller.

Except for one major difference. Miller will carry a device with him – about the size and shape of a cell phone – that will alert him when any of the players on the field suffers a significant hit to the head. The hit, or series of hits that may put an individual player in jeopardy of a head injury, will be timestamped with the player’s name and number on Miller’s hand-held device.

“On practice days, there are 80 or 90 kids on every corner of the field,” Miller said. “I can’t see everything. I’m going to miss stuff. So that’s really the most critical piece of having this.”

Or as Brebeuf athletic director Ted Hampton said, “There’s an ‘eye’ on the kids at all times.” That’s the idea, anyway. For the first time, Brebeuf has outfitted all of its players with the Riddell InSite Impact Response system. Each helmet is fitted with a five-zone sensor pad inside the liner that measures the severity of impact on hits to the helmet. When an impact or series of impacts exceeds a pre-determined threshold, Miller – or any trainer at a school using the system – receives an alert.

The system is not designed as a “concussion-prevention” device. But the technology could prove valuable in a sport that has faced increased concerns in recent years over the long-term effects of head injuries on all levels. A spokesperson for Riddell said Brebeuf is one of 619 programs at the youth, high school or college level as of Friday that are using the InSite system, which was first utilized during the 2013 season at a handful of schools.

It’s not a perfect science. One in-state college trainer said her InSite device alerted her five times in one game to an individual player sustaining a potential dangerous hit, though the player didn’t show any concussion symptoms in testing. The opposite has also been true. The system is expensive, a potential deterrent for already cash-strapped high school programs. InSite costs $150 per player and $200 for the alert monitor (in addition to the cost of the helmets).

Can technological advances like InSite propel the sport into a safer era? More data is needed. But trainers and coaches who have used the system believe it is a step in the right direction.

“It’s awesome for concussion awareness,” said Dr. Todd Arnold, a physician at St. Vincent Sports Performance with an extensive background in treating concussions and the team trainer for Carmel’s football program. “The more people talking about it, the better for the kids who play collision sports. There was a time when it was a taboo subject and nobody wanted anything to do with it.”

Erin Foresman is at the forefront among those who have used the InSite system on a day-to-day basis. Foresman is the head athletic trainer for the Division III Manchester University football program, which has used InSite since 2014 at the urging of former coach Shannon Griffith, who is now in a fundraising role at the school.

Foresman has utilized InSite to communicate information she might have otherwise missed. Last season, one Manchester player was consistently involved in hits that dinged Foresman’s hand-held device.

“We looked back at the way he was tackling on game film,” Foresman said. “We were able to fix the problem. In that sense, we were able to use it as a teaching tool.”

Like Miller, Foresman said the system gives her another set of eyes on the practice field. Players can’t just “shake off” a hit that exceeds the threshold or hope that it goes unnoticed. If Foresman is alerted by the device, she automatically puts the player through a sideline assessment.

But it’s not foolproof, either. Foresman said it’s become obvious in two years using the system that the hits are harder – or there can be more of them – on game day than in practice.

“That’s one thing I have trouble with,” Foresman said. “In games, they go a little bit harder. I had one player where the alert went off five times in a game, but he didn’t have any concussion systems when I tested him. That part makes it a little tough.”

Riddell outfits each sensor with a threshold based on the position of the player. For example, the impact of a hit to an offensive lineman’s helmet may not match that of a wide receiver. The thresholds are based on information the company has gathered since 2003.

Foresman has begun her own research to track how many times the alert system is dinged by position. The reality, Arnold said, is that each individual has their own threshold when it comes to sustaining a concussion.

“Until you know what someone’s individual threshold is, it’s not a tool you want to depend on completely,” he said. “But it is so much better than nothing.”

Riddell doesn’t promote InSite as a concussion-prevention system but as a tool to help trainers and coaches recognize issues before they mushroom. Players at Virginia Tech have been outfitted with sensors since 2003 (called the Head Impact Telemetry System), which is information Riddell has used in developing InSite. Arkansas, Iowa and Wisconsin are among the major college programs that have implemented InSite.

“We’re legitimately trying to protect the future of football,” said Hampton, the Brebeuf athletic director. “The approach today is much different than it was a few years ago. We’re smarter. Now we’re always looking for more we can do.”

Brebeuf isn’t the only program using InSite. Pendleton Heights has 38 helmets outfitted with the Riddell system, beginning last year under former coach and athletic director John Broughton and continuing this season under first-year coach Jed Richman.

“It’s good for a lot of reasons,” Richman said. “It’s good for the sport and good for parents. It’s another safety net.”

Elkhart Memorial and Huntington North are other Indiana high school programs that are at least partially outfitted with InSite, Riddell sales representative Erich Kennerk said. Other college programs now involved are Anderson and Butler.

If InSite proves a success, it could go a long way to alleviating concerns from parents. Kristin Roberts’ son, Jack, sustained a concussion in middle school before playing in high school at Brebeuf. Her younger son, Will, is now a senior defensive end at Brebeuf.

“When Jack got a concussion, it was a little overwhelming,” she said. “It was scary. But I feel reassured if this technology does what they say it will. Kids aren’t going to go to the trainer on their own. But I think this is a great step. I’m excited.”

Roberts admits that if her sons were 10 years younger, she might have a difficult time allowing them to play football. She’s not alone. Former players from Mike Ditka to Troy Aikman to Terry Bradshaw – and others – have said they’d have a difficult time allowing their sons to play football with their current knowledge of head injuries.

In March, the National Football League publicly acknowledged the connection between head trauma caused in the sport and chronic traumatic encephalopathy (CTE) for the first time.

But some inside the sport believe the “sky is falling” narrative is far from accurate. While youth participation numbers had been tracking down since 2010, USA Football reported 1.9 percent increase for ages 6-14 from 2014 to 2015. High school football participation nationally was down 2.5 percent from 2008 to 2015, but other factors (sport specialization) could also factor into those numbers.

“The game has been attacked for a while,” Brebeuf coach Mic Roessler said. “I hope what we’re doing helps. We need to protect this game. The barbaric coaching style of years ago has been brushed aside. We’re smarter and wiser. We’re not jeopardizing the safety of kids. That should give parents a sense of security. This game to me is the best life lesson a kid can have. For a kid not to play for fear of something happening is awful.”

In 2014, Indiana became the first state to require concussion awareness training for youth and high school coaches. At its May meeting, the Indiana High School Athletic Association approved a proposal from the Indiana Football Coaches Association that restricts contact drills. After the first week of games, teams may participate in a maximum of two practices per week involving contact equal to the “live” level.

“The best programs in the state are already adhering to those things,” Richman said. “The safety of the players comes first. That’s my job. The good thing now is that it’s common sense. It’s commonplace to put safety first. In that aspect, we’ve come a long way.”

It remains unclear if the InSite system will become the next new wave among local high school programs. The expense could prohibit some from following suit. But Roessler likes the idea of having another set of eyes on his players at all times.

“Every game means a lot to these kids,” he said. “They don’t want to miss anything and don’t think about the impact (a concussion) could cause. Hopefully this system will eliminate that. It’s really going to help us as long as we use the data and follow it. We’ll see things on the field that we normally wouldn’t.”


Athletic Trainer Organizes CTE Forum, Recognizes Victim


Article reposted from The Des Moines Register
Author: Morgan Gstalter

Symptoms of CTE include memory loss, confusion, mood problems, anxiety, depression, dementia and aggression.

“The most important symptom is when they say, ‘I don’t feel right,'” Hadden said.

CTE can only be officially diagnosed during an autopsy, and there are few confirmed cases for researchers to study.

Easter suffered five concussions while playing football at Indianola High School. The pressure to do well in sports and be the football star was documented in his writings, titled “My Silent Struggle.” His mother read some excerpts from his journals written before his death, in which Easter documents his struggles with post-concussion syndrome and CTE, starting in his sixth-grade year.

“I would literally use my head as a battering ram because I loved being able to bring it ,” Easter wrote, saying that he would use his head to blow down other players on the field who were bigger than him.

Easter’s former athletic trainer at Indianola, Sue Wilson, said that was part of the problem —  that children playing tough contact sports at such a young age don’t know the fundamentals of the game.

“We have to teach them how to control their bodies,” Wilson said.

Easter suffered from chronic pounding headaches, shoulder and neck aches and arm spasms throughout high school. He wrote that he was scared to tell anyone, because he knew he wouldn’t be allowed to play. And football is what made him feel good.

It was Zac Easter’s last wish that his family spread the word about his “silent struggle”  with CTE.

Chronic traumatic encephalopathy, or CTE, is a progressive, degenerative brain disease in people who have suffered severe head trauma. Easter had suffered seven concussions over the course of his 24 years, most of them from playing high school football. All of them led to a life of pain, medical uncertainty and emotional inconsistency.

Easter died in December, and to help accomplish his goal, his family and friends, his former athletic trainer and a college professor hosted a forum for about 100  Sunday at Simpson College through their nonprofit CTE Hope.

“His last wish was for us to provide education and awareness to families, athletes, people with trauma, so they can have information, hope, awareness and a prevention plan to help make football safer,” said Brenda Easter, Zac’s mother. “But most importantly, to help prevent another family from going through the nightmare that we went through.”

Mike Hadden, a professor in Simpson’s department of sports science and health education, has been a certified athletic trainer for more than 25 years. There’s so much we don’t know about CTE, he said, which has degenerative patterns similar to Parkinson’s disease and amyotrophic lateral sclerosis, or ALS, which also is known as Lou Gehrig’s disease.

Eventually, he told his mother and he began a series of doctor visits that led to expensive testing and a range of unnecessary medications.

“Not one doctor asked me if I played football,” Easter wrote.

Easter began suffering from constant and severe headaches, slurred speech, blurred vision, loss of balance, brain tremors and dementia. He sunk into a deep depression, and while attending Grand View University, he abused alcohol and his Adderall prescription, which was given to him after a misdiagnosis  for attention deficit hyperactivity disorder, or ADHD. He ended his life in 2015 in order to donate his brain to medicine so he could “tell his story.”

“I know there’s a kid out there going through something similar,” Easter wrote. “I beg that you get help.”

ConcussionPreventionSecondary School

El Paso Athletic Trainers Looking for Funds to Prevent Concussions


video platformvideo managementvideo solutionsvideo player

Ysleta ISD’s athletic trainers are asking the board for money. They want to beef up how the district tracks concussions and athletic injuries.

These athletic trainers want to track when a student gets a concussion and how many students are getting them. That way they can watch and avoid the situations that lead to these dangerous injuries.

YISD high school football players sustained 84 concussions last school year. A concussion is the movement of the brain inside the skull, causing bleeding and injury. YISD coaches want to monitor players who’ve sustained them in the past.

“With this system, we can keep a tally of how many concussions and athlete has sustained, not just in the current athletic ye but in the athletic years prior to this point,” said Casey Rangel, athletic trainer of Hanks High. “This way we have a longitudinal set of data to determine whether or not it is safe for an athlete to continue on or whether or they need to sit out from activity to protect their cognitive function.”

At a board workshop, YISD’s athletic trainers are asking for an investment in an online program called Rank One Sports. It helps coaches track injuries. Right now each of YISD’s high schools is using the program in some capacity, but the trainers say they need more. Namely, they want the program in middle schools, WiFi in the field houses so coaches can log on, and iPads for coaches out on the field.”

“We can pull up diagnostic tools like impact tests, scat testing, to make sure an athlete is actually concussed,” Rangel said.

The goal is to go completely digital, allowing parents to also use the site to send in permission slips and physicals. The group is working on getting the board a dollar figure for how much they need. They hope to do that by next week, and if the board approves, getting the program in schools by next year.


ConcussionPreventionSecondary School

Montana Athletic Trainer Provides Concussion Expertise

2776b52a52614ed1d840b0383b5e3a5f.jpeg | Great Falls, Montana

Every time student athletes step onto the field, the court, the course, the mat or jump into the pool, they lay their hearts on the line.

But play too hard and hearts aren’t the only things on the line.

“A concussion is when the brain sloshes against the skull and there is some neurological issues that happen in the brain when they get hit,” explains athletic trainer Teayre Klosterman. She oversees the athletes at C.M. Russell High School in Great Falls.

She’s been there seven years and says concussion numbers have climbed: “We are seeing an increase, but we’re seeing an increase only because of the fact we’re looking for them now. We used to call them ‘Oh, you got your bell rung.’ Well getting your bell rung was getting a concussion.”

The Centers for Disease Control and Prevention describes concussions as traumatic brain injuries.

They can be caused by a blow to the head. Even a hit to the body can cause the head to move quickly enough, the brain ricochets or twists, leading to a chemical change in the brain.

Signs and symptoms include appearing dazed, memory problems, headaches, losing consciousness and even personality changes.

Klosterman says concussions are different for each student and different each concussion.

High school sports concussions are most common include football and girls soccer, though school officials say they can result from just about any sport.

According to school officials, between August 5, 2015 and January 25, 2016, a total of 20 girls and 56 boys have gone through concussion protocols.

In March, Great Falls School Trustees passed the district’s first concussion policy: Policy 3415. School officials say installing the new rule was easy because the district already had protocols in place for years.

Here’s the process: Klosterman says if they suspect an athlete has a concussion, they pull them out of play and perform a sideline procedure. There she checks their eyes’ dilation, their body control and their memory.

Occasionally she’s tipped off by team members if something seems strange.

“I had a young man who played football here at CMR for four years. His senior year he sustained a concussion and couldn’t remember what a specific play was. And his teammates were like ‘Uh he is not acting right.'”

Next they take the ImPACT test, a computerized neurological test checking speed, reaction and memory.

Student athletes take the test before the school year to create a baseline. When a student retakes the test, they have to be comparable to their baseline to pass and move forward. All the results have to be okayed by a doctor.

From there it’s a step by step progression of light exercise to partial practice participation to full participation. Students must also not show any symptoms each day to progress.

Klosterman says recovery usually takes 5 to 7 days.

But school officials are finding some drawbacks with the ImPACT test.

GFPS athletic director Gary DeGooyer says, “Supposedly some of these kids can remember these things or memorize the test, so even with a concussion they might be able to pass it.”

Klosterman says the test will need to adjust to improve, especially since kids take the test more and more at a younger age.

But she says ImPACT has done a great job changing the program.

Klosterman calls seeing a student return to play after a concussion satisfying.

“You know you’ve stepped them through and you know you’ve stepped them through correctly and that’s probably the biggest thing. Knowing that you’ve done what you’re supposed to do.”

And the students can get back to playing the game.

For a link to the policy:

For a link to the CDC’s HEADS UP program:



Athletic Trainer’s Resolve Helps Patients


Through four crisp fall seasons at Pemberton Township High School, not many shots got past soccer goaltender Tommy Ayrer.

Nimble and quick-thinking, Tommy so stingily defended the Hornets’ net, he started at the position throughout his high school career. But in an unlucky instant, that career came to a sudden halt.

During a game in his senior year in 2013, Tommy collided with another player, taking a visibly nasty knock to the head. His mother, Karen Ayrer, took him to an emergency room.

There, she recalled, she was told Tommy was fine. Satisfied with the diagnosis, she was shocked when school athletic trainer Eileen Bowker refused to allow him to return to play.

Undeterred, Karen Ayrer took her son to a pediatrician, who also cleared him to play. Again, Bowker refused to follow suit.

Tommy needed to undergo testing and a more stringent protocol before returning even to the practice field, she insisted. And that testing revealed he had, indeed, suffered a concussion, school officials found.

“I was aggravated,” Karen Ayrer said. “I was livid, and he (Tommy) was livid. … I’m thinking, if a doctor says my kid doesn’t have a concussion, he doesn’t have a concussion.”

She appealed to other school officials, and Tommy repeatedly asked to be put back in, to no avail. Frustrated, they eventually gave up. Tommy would undergo further evaluations and rest time, as required, before finally being cleared to return.

“I’m pretty sure he sat out for a good eight to 10 games,” Karen Ayrer said.

Convinced that Bowker was being heavy-handed, the mom felt the resentment simmer. Ayrer never thought that two years later, she would thank the athletic trainer for her resolve.

After all, it just may have saved her son’s life.

Karen Ayrer was just one of many angry parents to whom Bowker has stood up to in her 30 years as an athletic trainer.

As in the Ayrer case, many protest her decisions not out of apathy toward their children’s health, but out of ignorance as to how cautious they must be in detecting a concussion and how drastic the consequences can be if an athlete returns to action too early after suffering one.

According to the Centers for Disease Control and Prevention, as of 2010, at least 3 million sports- and recreation-related concussions occurred each year in the United States.

A concussion occurs when the brain is jolted by a blow to the head or neck, or even a jolt to the body overall. It may cause bruising, damage to blood vessels or nerve damage.

A person does not have to be knocked unconscious to suffer a concussion, and may not remember if he or she did lose consciousness.

A concussion can result in impaired mental and physical function that can continue for a wide range of time. Symptoms include headache, a feeling of pressure in the head, confusion, amnesia of the time surrounding the injury, nausea, fatigue, vomiting, slurred speech and others.

A victim may also suffer from depression, concentration or memory difficulties, irritability and other personality changes, sleep problems and other issues.

Repeat concussions can cause longer-term or permanent mental and cognitive problems. Returning to play too soon after a concussion presents the risk of second impact syndrome, a severe condition caused by a second concussion that occurs before the first one has properly healed.

Second impact syndrome can result in severe brain swelling, brain herniation, and other problems that greatly increase the risk of death.

That’s why New Jersey law mandates that any student suspected of having suffered a concussion must be sidelined and cannot return to activity until cleared by a doctor trained in evaluating and treating concussions.

A new bill introduced in the Assembly on Feb. 4 would require a public school student suffering a concussion to be cleared by such a doctor to return to school altogether. The bill has been referred to the Assembly Education Committee for consideration. The Senate version has passed that chamber’s Education Committee and will move on to a second reading.

Sidelined, for as long as it takes 

School officials throughout Burlington County and well beyond have buckled down harder than ever in recent years in spotting concussions and other head injuries when they occur, and keeping players sidelined for as long as it takes.

High schools, including Pemberton Township, require all student athletes to undergo baseline testing, an evaluation of mental function under normal circumstances.

When a concussion is suspected, the student takes the same test, and the results are compared with the baseline to help determine if he or she is actually concussed. That’s just one of several tools trainers and doctors can use to make a diagnosis.

Another tool is the SCAT3 (Sport Concussion Assessment Tool-3rd edition), which is also used to help make a determination. The evaluation measures indicators such as memory, concentration, physical balance and coordination, among others.

Once a concussion is diagnosed in Pemberton Township, Bowker said, the student must complete several layers of requirements before returning to competition.

To start, she stresses that the student must rest, and that means real rest.

“That means no texting, no computer, no TV,” Bowker said. “Just really sleeping to let that brain recover.

“In my experience, those who really rest in the first 24 to 48 hours after a concussion end up returning quicker,” she said.

“For those who don’t listen, it’s not as good. Their headaches and other symptoms may get worse.”

Bowker said recovery time can vary widely. It can take a week, month, four months, even longer.

“Every concussion is so different, you really can’t give an average,” she said.

In any case, a student at Pemberton Township must be free of all symptoms for at least 72 hours before he or she can even think of returning to play.

“The student might start by riding an exercise bike or running on a treadmill or using an elliptical for a while, just to get the heart rate up,” Bowker said.

Another day without symptoms can mean some cardiovascular work or circuit training in the weight room, she said. And day three symptom-free could mean limited practice, without contact.

The following day, the student would take the baseline test. If the score is back to the original baseline, he or she then sees a physician, who must give the all clear for a return to play.

Precautions also go beyond high school. In February, the Marlton Recreation Council in Evesham, which runs 15 sports programs for kids, chose a local physical therapy provider to conduct baseline testing for 5,000 athletes.

M&M Physical Therapy administered the tests before the start of spring sports in March for children age 10 and older. The provider offered to test for $25, with part of the fee going back to the recreation council for sports programs.

M&M said it would conduct post-concussion tests at no cost.

The Burlington County Youth Athletic Association has also embraced the move toward greater concussion awareness.

While its coaches are already trained in state-mandated safety standards, the association is now going beyond that.

“With the help of the Willingboro Recreation Department, starting this season, all of our coaches and volunteers are required to undergo concussion training,” association president Chuck Esser said.

The organization offers baseball and softball programs for kids between 3 and 15. About 150 to 200 are registered, Esser said.

About 90 percent of participants are from Willingboro, he said, with the rest coming from neighboring communities like Edgewater Park and Riverside.

Media attention focused on the litany of health problems suffered by former NFL players has helped propel the treatment of concussions and other head injuries to the forefront of high school and youth sports.

Ex-players suffered from a range of conditions, including depression, early onset dementia and other psychological problems, with a number of suicides being blamed on complications from repeat concussions.

But reform efforts in Burlington County and elsewhere well predated the $1 billion settlement the NFL made with thousands of ex-players suffering from repeat brain injuries last year.

Pemberton Township instituted baseline testing in the early 2000s.

Concussions hit most sports

And while Americans tend to think first of the gridiron when they hear of concussions, Burlington County experts say the problem is widely distributed.

Bowker said just under 40 concussions were reported at her school last year. They spanned soccer, football, baseball, softball, tennis and cheerleading, she said, and soccer yielded more than football.

Mark Haines, athletic trainer at Rancocas Valley Regional High School in Mount Holly, said his school sees an average of about 25 reported concussions per year.

“It varies,” said the 34-year trainer, who is set to retire at the end of this school year. “We could have 29 one year and 24 the next. They’re mostly in football and soccer.

“This year, we had two cheerleaders suffer concussions,” he said. “We also had a tennis player and a volleyball player.”

Haines said many soccer concussions occur because of collisions. He and Bowker said cheerleaders may suffer them after bumping heads or taking an elbow from a teammate during stunts.

They can often occur as the cheerleaders are learning and practicing moves.

Paul Kasper, director of sports medicine at Virtua Health System, concurred.

“If you look at the physical conditioning of cheerleaders, they’re really pushing the boundaries of physical ability,” Kasper said.

“It’s pretty common when they’re learning, that they’re bumping heads. I think the challenges cheerleaders are expected to undertake are increasing,” he said. “They’re being asked to be more dynamic.”

Kasper said cheerleading is one of the sports, along with girls soccer, in which reports of head injuries are increasing.

“Historically, football, lacrosse, hockey and soccer have had higher rates of concussions,” he said. “Whenever those sports are in season, we see a general rise.”

Kasper said Virtua can receive reports of concussions in kids around 10-12.

“There’s a combination of reasons,” he said. “They’re starting to grow physically. As they enter puberty, they’re starting to grow bigger and stronger. But they can be uncoordinated early on, and collisions occur in which they injure themselves or their opponents.”

Bowker thinks back roughly two decades to when she worked as a trainer at Northern Burlington County Regional High School in Mansfield when she’s asked about how much attitudes have changed regarding head injuries in sports.

A football player there once visited the school nurse two weeks after a game in Delran with a bad headache, she recalled.

Perhaps his recollection of the game could help shed light on when and how his headaches had begun. The problem was he had no memory of the game.

The player later learned that, during the game, teammates had been picking him up and directing him to his place on the line of scrimmage after his injury, which turned out to be a concussion.

The case highlights the drastic turnaround in how head injuries are treated from the start. The contrast is seen in how a tennis player’s injury was addressed at Pemberton Township recently.

The girl was struck in the head by a serve from her teammate in a doubles match, Bowker said. She experienced common concussion symptoms — headache, nausea and loss of balance, among others.

As officials stuck to protocol in treating the injury, the student was out of school for about a week, Bowker recalled. She was out of competition for nearly nine months before she was functioning normally again.

‘It’s tough for the kid’

Haines, too, remembered the days when a player who took a hard hit or seemed dazed and confused was said to have been “dinged” or “had his bell rung.”

“They no longer say that,” he said. “If there’s any question at all of whether an athlete has a concussion, he or she is out and sees a doctor.

“It’s tough for the kid, because like any other injury, you tell him, ‘You’re done until you’re cleared to come back,’ ” Haines said.

“And that in itself is a bombshell for a kid, especially for varsity players, seniors, the upper-level players. If a kid is a No. 1 seed in a tournament, that’s devastating.”

But as thousands of former pro football players — and at least one grateful Burlington County mom will attest — it’s well worth it to sit out for a while.

Two years after she’d campaigned so hard to get her son back on the soccer field, Karen Ayrer learned that such a return could have been a terrible mistake.

Tommy, now a sophomore at Rowan University, had at times been slow to respond to her, she recalled, had issues with “spacing out,” as she put it, and had difficulty concentrating.

The issues may be due to what are known as silent seizures — not obvious all-out seizures — but short periods of blank stares potentially caused by abnormal brain activity.

While consulting a doctor on the issue, the question arose, “Has Tommy had any concussions?”

The question alone was an epiphany for Karen Ayrer, but it also posed a more frightening question: What if Bowker had relented and let Tommy back on the field?

She recently apologized to Bowker for her resistance, admitting that the staunch trainer had made what could have been a critical call.

“If he had been put back in, he might not be here today,” she said.

Karen Ayrer added that she now defends Bowker against parents angered when their children are taken out of competition because of head injuries.

“Parents have to listen to the athletic trainers,” she said. “She (Bowker) is making them sit because she wants them to live. And if she let them play, and something happened to them, she would never forgive herself.”

 Joe Green: 609-871-8064; email:; Twitter: @JoeGreenBCT


North Georgia Joins DOD Concussion Study


The University of North Georgia (UNG) is one of three National Collegiate Athletic Association (NCAA) Division II schools to recently join a national initiative that aims to prevent, diagnose and treat concussions.

The $30 million initiative pairs the NCAA and the Department of Defense (DOD), and now includes 30 institutions of higher education across the country. The collective is titled the Concussion Assessment, Research and Education (CARE) Consortium. The nine recent additions announced earlier this month — including UNG — will begin adding their data to the study this summer.

“UNG is honored to be chosen as a participant in this landmark concussion study,” said Director of Athletics Lindsay Reeves. “Student-athlete welfare is paramount in our mission at UNG, so we are glad that we can assist with this important research initiative and return-to-play protocols.”

To participate in the study, all UNG student-athletes receive a full preseason evaluation for concussions with follow-up checks in the event of an injury. The collected data will be sent to a team of researchers for tracking and study.

So far, more than 25 million data points from 16,000 student-athletes have been collected from the 21 institutions already participating. With the nine additional sites, researchers estimate that more than 25,000 student-athletes will participate during the three-year study.

“The important expansion of the CARE Consortium to include a diversity of Division I, Division II, Division III and historically black college and university participants further solidifies this study as a groundbreaking initiative,” said Brian Hainline, NCAA chief medical officer. “It is a remarkable collaborative and inclusive effort.”

The NCAA and DOD have dedicated $30 million to the concussion study and to an initiative to spur culture change regarding concussion. Participating schools receive a portion of that funding to cover the cost of carrying out the research.

According to Matt Daniel, head athletic trainer at UNG, national interest in concussion treatment and prevention has gained momentum in the past few years due to leaps in knowledge and understanding of how the injuries present in athletes.

“Concussions are very difficult to evaluate and identify; each situation, injury and athlete is different. Recovery rates are also different for each person and each event,” Daniel said. “The brain heals very slowly, so it is critical that we prevent or correctly diagnose concussions as often as possible. We are becoming more educated about how severely effects can present and how they can impact the individual. The more we as athletic trainers and medical professionals learn, the more our society learns and becomes interested in supporting these initiatives.”

Daniel said that problems after a concussion occurs can present hours or days after the injury happens. In an effort to protect UNG student-athletes, one portion of the university’s concussion protocol includes online cognitive baseline testing, to help athletic trainers establish how the university’s student-athletes function when they are injury-free. This gives them data for comparison if a student-athlete suffers a head injury.

“If someone is injured and we must do a sideline examination, we have a return-to-play protocol that mandates the student-athlete must undergo more cognitive tests to make sure they meet or exceed the baseline scores that he or she achieved before beginning the season. We are very thorough in our examinations; we also have a team neurologist 20 minutes away in case an emergency ever arises.”

Numbers vary, but UNG athletics typically diagnoses about 10 concussions per year among its more than 225 student-athletes. According to data collected by the CARE consortium, an estimated yearly average of 10,500 college athletes have sustained concussions for the past five years, and more than 320,000 brain injuries have been reported among American service members since 2000.