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#AT4ALLConcussion

Athletic Trainers Lead the Concussion Battle, Says Neurologist

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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

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Article reposted from NWI.com
Author: 

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.”

Research

Tragedies propel Iowa Athletic Trainer to take leading role in concussion research

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Article reposted from The Des Moines Register
Author: 

Mike Hadden couldn’t comprehend what was happening to his beloved niece.

Alex Hermstad was 12 years old when she started experiencing weakness in her hand, leading to an alarming diagnosis — amyotrophic lateral sclerosis, commonly known as ALS, a disorder that typically doesn’t strike people until their mid-50s. Her identical twin sister, Jaci, had no such symptoms. On Valentine’s Day in 2011, Alex died at her Storm Lake home. She was 17.

Hadden, a scientist and a health care professional who is one of The Des Moines Register’s People to Watch in 2017, restlessly probed for an explanation. As director of athletic training at Simpson College, he was also troubled by seeing the damage young athletes were suffering from concussions. He searched for a link, theorizing there had to be something in the environment making young people more susceptible to such trauma.

He devoured some 15,000 scholarly articles, and took a sabbatical year from Simpson to conduct his own research.

Hadden returned to work only to confront another family’s grief over another incomprehensible death to someone far too young. Zac Easter was 24 years old when he took his own life Dec. 19, 2015, driven to despair after six diagnosed concussions left his brain ravaged by chronic traumatic encephalopathy, also known as CTE. Repeated concussive blows to the head have been shown to lead to CTE. Hadden had known the Easters for years, from the time Zac’s father, Myles, was the football coach at Simpson.

That was when Hadden — with assistance from Jill Wilson, who was the athletic trainer at Indianola High School when Easter played football there — embarked on a potentially game-changing research project on concussions from his modest office at Simpson College, a liberal  arts school in Indianola with fewer than 2,000 students.

‘Something’s going on’

Hadden immediately reached out to a family that wanted the same thing he did — for something positive to emerge from tragedy.

“I had experience with a severe loss like that, and I knew the terminology. I knew how to get things moving. I knew what had to be done. We made sure to save tissue from Zac in case we wanted to do further tests,” Hadden said.

“There’s obviously something going on. ALS in a 12-year-old? CTE in a 24-year-old? That kind of stuff doesn’t happen.”

Hadden sent tissue and fluids from Easter to Dr. Bennet Omalu in California. The forensic pathologist — famously played by Will Smith in the movie “Concussion” — confirmed that Easter suffered from CTE.

The Easter family enlisted Hadden’s help in establishing a nonprofit organization called CTE Hope. The goal is to fulfill Zac Easter’s dying wish of making football a safer sport and to establish a reliable return-to-play protocol for athletes who have been concussed.

MORE: Zac Easter’s battle with CTE

Hadden obtained saliva samples from three Simpson football players who suffered concussions, carefully storing the samples in minus-80 degree temperatures. Hadden and others hope that doctors and sports trainers worldwide will be able to use a simple test to determine when an athlete has a concussion and, more importantly, when it is safe for him or her to return to the sport.

All from a simple spit test.

“That’s our missing link in all of this. Because we can’t evaluate the brain like we can a knee, shoulder, ankle,” said Wilson, who is also an adjunct professor at Simpson. “It’s going to take the discussions out and the questions out from parents, coaches and athletic trainers. Because it’s not fun to be that person on the sideline to release them to play and every time they take a hit, you cringe, because you don’t know what’s going to happen.”

The spit test

It is estimated that 1.5 million athletes suffer concussions each year. But experts fear 60 percent of concussions — potentially an additional 2.5 million — go undiagnosed under the current protocols. Also of concern is that the current five-step protocol for allowing an athlete to return to his or her sport — the so-called Zurich guidelines developed in 2008 — is imperfect. Those guidelines call for the gradual increase of physical activity before a concussion-sufferer returns to play.

The idea for a solution came to Hadden last March, when he read an article by David Walt, a professor in the chemistry department at Tufts University in Boston. Walt’s group is at the forefront of efforts to diagnose illnesses from saliva rather than blood using a “single molecule analysis.”

Concussions have long been linked to a spike in certain protein levels in the brain. If those “biomarkers” can be detected through a patient’s saliva, in theory doctors and athletic trainers could keep collecting samples until they knew those proteins had returned to the normal range, taking the guesswork out of the diagnosis.

To start, Hadden collected saliva samples from 93 of Simpson’s 130 football players this fall, plus another dozen from women’s soccer competitors, all of whom volunteered to be part of the project. These were stored to establish a baseline of the protein levels that were present in the saliva of the healthy athletes.

The sports seasons unfolded with relatively few concussions — great news, Hadden is quick to point out — but he did diagnose three football players who suffered concussions at home games. The initial saliva sample needed to be gathered in the first 20 minutes after the injury, then stored at minus-80 degree temperatures while transported to the freezer being used by Hadden. He kept a cooler and a supply of dry ice in his office, to be prepared.

Hadden kept gathering saliva from the injured players — 24 hours out, again at three days, at one week and, ultimately, after they were pronounced symptom-free. All of the telltale spit will be shipped to Tufts this winter, when Walt and his crew have some room in their schedule of tens of thousands of analyses they conduct each year. Walt said the tests take about four hours, and he hopes to have results within two days. He’ll be looking for elevated protein levels and how quickly those moved back to the athlete’s “baseline” stage.

Hadden said two of the football players progressed normally from their concussions, but the third had a relapse. He is curious to see what the difference was in their saliva.

If successful, Hadden envisions a time when trainers like himself can diagnose concussions armed with not much more than a cotton swab.

Hadden hopes to be able to release the results to the medical community by the next CTE Hope fundraising gala on April 21 in Indianola. He’s also hopeful that his studies can be broadened to include other universities in Iowa, so that the sample sizes can be much larger going forward.

Providing ‘Hope’

It’s this kind of work that drew the Easter family to Hadden when they started the nonprofit. Brenda Easter — Zac’s mother — said Hadden provides the scientific mastery while she handles public relations for CTE Hope.

“I have all the confidence in Mike and the work that he has started. If the saliva testing isn’t the right method to evaluate a trauma to an athlete, then we go to blood or we go to urine. He’s going to pave the way. He’s that committed and he’s got that kind of energy,” Easter said.

“We do have a bond. He lost his niece to a horrible disease. And while they’re a little further ahead with ALS testing, CTE is in the same boat. Neither one has a whole lot of firm treatment programs or protocols to follow when people are diagnosed,” she said.

Now Hadden’s work with CTE Hope, a mission that arose out of the deaths of Alex Hermstad and Zac Easter, may put Hadden on a national stage. If so, it would be their legacy, not his, Hadden said.

But he’s already fulfilled Brenda Easter’s late son’s dying wish.

“If something like (CTE Hope) existed when my son started to have the symptoms, I would have just been so blessed to know that there is a place and they know how to treat it. Zac said to me more than once, ‘Mom, there is no hope for me.’ And he wasn’t wrong,” Brenda Easter said.

“This work was Zac’s wish. It’s not like you can buy a gift for him any longer, and so the only gift I can give him now is to carry out his wishes. And we’re so blessed to have someone as compassionate as Mike to lead the way.”

MIKE HADDEN

AGE: 50

LIVES: Indianola

EDUCATION: Bachelor’s in biology/physical education at Buena Vista, 1990; master’s in sports administration/biomechanics at Kansas, 1997.

CAREER: Director of athletic training and professor in department of Sports Science & Health Education since 1997; head athletic trainer at Mercy-Des Moines Sports Medicine and athletic trainer at Des Moines Roosevelt High School, 1991-97

College and University

Colorado Mesa Head Athletic Trainer is Not playing head games

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Article reposted from The Daily Sentinel
Author: Patti Arnold

You can see a broken bone on an X-ray, the swelling from a sprained ankle.

Physicians and athletic trainers know roughly how long those injuries take to heal.

A concussion is the hardest injury not only to diagnose, but to manage. And it’s become increasingly apparent that long-term health problems can arise from even what’s thought to be one mild concussion.

“There’s probably no bigger issue right now than concussion management in the field of sports medicine,” said Josh Fullmer, Colorado Mesa’s head athletic trainer and assistant director of athletics for sports medicine. “It’s just the elephant in the room at this point, that’s what everybody’s talking about, what everybody’s focusing on.”

Data compiled by the NCAA from 2004-2014 shows wrestlers have the highest rate of concussion during competition, with 3.2 concussions per 1,000 athlete-exposures.

Football is second with three concussions per 1,000 athlete-exposures.

Diagnosing a concussion is the first of several complicated steps in concussion management.

Every one of the myriad of symptoms varies from athlete to athlete. There’s no definitive test, no X-ray or MRI that can show a concussion has occurred. If Fullmer or a member of his staff even has an inkling one of the players has been concussed, he or she is removed from practice or the game.

“We have to go off of what their symptoms are, our gut feeling sometimes,” Fullmer said. “A student-athlete gets hit and is acting a little goofy but they’re saying I’m perfectly fine, and we go through the balance testing and cognitive testing and they check out, technically they’re cleared to play, but sometimes they’re just not right.

“That’s when that gut feeling comes into play. Obviously if there’s a question one way or another, we’re gonna hold you out and assume the worst and not going to risk it.”

Not worth the risk

Last fall, CMU quarterback Sean Rubalcaba was involved in a helmet-to-helmet collision during the second game of the season. As he was scrambling and going to the ground, a Midwestern State University defender hit Rubalcaba in the side of the head, leading with his helmet.

Rubalcaba stayed on the ground for a few moments and was checked on the sideline by medical personnel. He did not return to the game.

He passed the sideline concussion exam, but that “gut” feeling came into play and the Mavericks weren’t willing to risk his health. Rubalcaba returned to practice the next week after passing concussion protocol.

CMU football coach Russ Martin said afterwards that no game was worth risking a player’s health, and that’s the stand the athletic department maintains in all sports. Fullmer said there’s been no pushback from any coach since he’s been at Mesa about any injury, especially suspected concussions.

As more and more studies are done on concussions, long-term effects and how best to treat head injuries in sports, it’s gotten a little easier to manage them, because guidelines have been mandated. Still, there’s no way to definitively know if the brain has completely healed from a concussion and there will be no long-term effects.

“I tell my students all the time, you can look at an X-ray and you know if a bone is broken. We know it’s 4-6 weeks and they’ll be back,” Fullmer said. “Concussion management is nowhere near that easy. We have to really rely on the student-athlete and their honesty.”

CMU requires student-athletes to sign a form pledging to be forthcoming with all medical information.

Baseline tests required

The NCAA requires every student-athlete to take baseline tests, called SCAT3, before they are allowed to practice or play. If a concussion is diagnosed, several steps must be taken before they are cleared to return to practice.

The SCAT3 provides medical history and behavior of the student-athlete when healthy. A history of prior concussions warrant the ImPACT computerized test.

“That’s probably the most common baseline computer test out there,” Fullmer said. “It’s not feasible to baseline (ImPACT) test every student-athlete.”

The ImPACT test must be given with minimal distractions, so you can’t put 30 or 35 student-athletes in a computer lab at once. Every student-athlete who has had a concussion or has a learning disability, ADHD, dyslexia or a history of migraines or frequent headaches is ImPACT tested.

The baseline tests are compared with post-concussion tests to help determine whether the concussed student-athlete has recovered to his or her “normal” neurological status.

Concussion specialist

In 2011, Western Orthopedics and Sports Medicine, which treats CMU athletes, hired Dr. Danny Mistry, who is the Mavericks’ primary care physician.

A concussion management specialist, Mistry helped develop concussion management protocols for CMU and School District 51. He’s also a member of the Concussion Task Force in Grand Junction, which provides educational programs and guidelines for concussion management, with financial backing from Community Hospital.

As CMU athletes go through the post-concussion protocol, they must be cleared by Mistry or another physician before they return to play.

Mistry knows he might not be popular when he tells an athlete he or she isn’t cleared to compete after a concussion, and he’s OK with that.

“Please be patient,” Mistry said. “Attention to detail is important. The brain has a remarkable power of healing, and an integrated approach to concussion management is key.”

Some athletes need only a few days to recover and clear concussion protocol. Others can take several days, weeks or months. There’s no way to predict recovery time for the brain.

Along with concussion protocol, the NCAA has made other, more subtle rule changes to help recognize concussions.

One of those is no longer allowing football players to wear tinted visors. The reason? Officials on the field need to be able to see the players’ eyes.

Always on the lookout

On the sideline, Fullmer and his staff are always on the lookout. He and at least one assistant trainer move up and down the sideline of football games, intently watching players get up from tackles.

“We’re watching very carefully at the end of every play, watching as the players unpile and get up. Are they kind of woozy or are they moving around coming off the field? Are they able to run effectively?” Fullmer said.

“A lot of it is knowing our athletes. There are some that are goofy and can’t balance worth a darn to begin with and there are some that do very well. We’re looking for some of those things as a team changes.”

Because of the sheer number of players and the amount of contact involved, Fullmer said football has the most concussions at CMU, but they can, and do, occur in nearly every sport. Coaches are trained to help spot symptoms, and the same caution is taken and protocol followed in every sport.

Trainers are at every practice and game, always keeping an eye on athletes, especially when they hit the floor or ground or make hard contact with another player.

Headers, slide tackles or diving to make a save in soccer can produce concussions. Basketball and volleyball players can hit their heads on the wood court diving for a ball, running into another player or getting elbowed in the head.

An errant tennis shot that hits a player in the head can cause injury — there’s no limit to what it takes for the brain to be jarred into the skull.

If athletes, parents, coaches and medical personnel are patient and follow protocol to the letter, Mistry said, the chances of long-term effects are minimized. He wants athletes to achieve their goals, but reminds them they need their brains to live.

“The steps are very clear, no symptoms, normal exams, normal brain function testing, no academic adjustments, because return to learn is as important, if not more important, and then a graded return-to-play protocol as described in international guidelines, the Zurich guidelines,” Mistry said.

“It’s not rocket science. People get better when you pay attention to detail. There is no question.”

Athletes have asked Fullmer how many concussions they can withstand before they can’t play again. His answer: It could be one, it could be several. There’s no way to know.

He just knows you can’t be too careful.

“With the second-impact syndrome that can happen and actually take someone’s life, it’s a significant thing,” Fullmer said. “It’s frustrating for us because there’s no Band-Aid we can put on their forehead that says concussed or not concussed.”

Research

Bowling Green Professor Studies Effects of Concussions

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Article reposted from The Blade
Author: 

When a student-athlete suffers a hit to the head on the playing field, a protocol is observed to determine if a concussion has been sustained.

How long does it take for that athlete to recover from a concussion? What happens in the classroom and who does he or she turn to for help?

That’s where my research at Bowling Green State University’s School of Human Movement, Sport, and Leisure Studies, comes into play. My main research concentration is sensory impairment after concussions: how vision, hearing, and the somatosensory systems are compromised. In addition, she looks at academic decline after a concussion to investigate whether a student’s GPA regresses.
What we’re seeing is that a lot of college students don’t know how to talk to their professors about the challenges they face in the classroom. Even just going to class under the fluorescent lights can be a huge detriment to learning for a student who has sustained a concussion.

College kids don’t understand how much concussions affect them. They might not be able to study, concentrate, or even read a book. Sometimes they can’t even hold a conversation without the symptoms being provoked again.

My aim is to determine if visuo-motor processing deficits, which can occur after concussions, can improve through therapy, which may also reduce recovery time.

So far, one concussion doesn’t seem to be a problem academically, but subsequent concussions can have a much higher impact on students’ “return to learn,” as the NCAA and the Centers for Disease Control have called it.

Symptoms of a concussion include headaches, difficulty remembering, difficulty sleeping, sensitivity to noise, nausea, and sometimes vomiting.

Obviously, headaches are probably one of the biggest symptoms. Students often feel like they are in a fog.

Once an athlete has had a concussion, research suggests he or she is four times as likely to sustain a second concussion. From there, an athlete is 10 times as likely to sustain a third concussion, and the susceptibility continues to grow.

My main goal is to have a better understanding of how to help students in the classroom and what we need to do to get information out to teachers and professors so we can assist them in the classroom.

Even though football concussions get a lot of attention in the media, women’s ice hockey actually has higher incidence rates. Athletes in all sports can get a concussion, not just contact sports. Football numbers are the highest, but the percentage rates of players that sustain concussions are actually highest in hockey.

You hear about football because schools have the greatest number of athletes playing and participating in football. You’re actually more likely to sustain a concussion playing women’s soccer, rugby, lacrosse, or ice hockey.

My research is focused on college athletes, but I plan to study high school-aged student-athletes in the near future.

My plan is to set up preseason testing for the surrounding Wood County schools so athletes can set a baseline standard before they begin participation. Then if they ever get a concussion, I’ll be able to retest them so I can provide the student-athletes and their physicians with a better assessment than they would typically get in an office.

The evaluations before and after would offer a basis for comparison.

I would do some balance testing with them, as well as cognitive testing and some visual testing just to get a baseline measure. And then if they do get a concussion, I would repeat the measures to see how they are changing.

Ultimately, I want to make student-athletes more aware of concussions and what they can do to aid their recovery so they don’t get lost in the classroom.

The media is doing a great job of bringing concussions to the forefront, but at the same time it is a scary situation if you’re not well-informed. Getting the truth out about concussions is important. If I could change the world, I’d like to make sports safer. That is a big goal.

Andrea Cripps, PhD, is a certified athletic trainer who joined Bowling Green State University as an assistant professor in 2015. Ms. Cripps’ research interests include how the sensory systems — visual, vestibular, and somatosensory — are affected following a concussion and how these impairments affect upright balance. For more information, visit bgsu.edu. Bowling Green State University will have a science column featured in The Blade on the last Monday of every month.

 

 

ConcussionPreventionSecondary School

El Paso Athletic Trainers Looking for Funds to Prevent Concussions

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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.

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ConcussionPrevention

Athletic Trainer’s Resolve Helps Patients

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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: jgreen@calkins.com; Twitter: @JoeGreenBCT

#AT4ALLSecondary School

New Mexico Athletic Trainer Coordinates Ultimate Sports Physical

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Jennie Coyle, 45, of Las Cruces, knew that by being involved in school sports, her four sons — all basketball players — were at risk for injury.

Before each sports season began, Coyle was required to attend a parent meeting to watch a video on the signs and symptoms of a concussion, a type of traumatic brain injury. But she never thought it would happen to one of her sons, until her 14-year-old son Noah, a basketball player at Mesilla Valley Christian School, hit his head during a game in late February.

“My son was jumping up to catch the ball and the other player didn’t see him and ran straight into my son and his head hit the floor,” Coyle said. “He was just lying on the ground, out cold, and his eyes were open.”

When Noah was able to stand up and walk to the bench, Coyle said she could tell there was something wrong with him because his eyes were red and he said his hands had gone numb.

It was later confirmed that he had a concussion and Noah took 10 days to recover before he was allowed to return to play with his teammates.

“We definitely still want him to play and we love the sport,” Coyle said. “But especially since he has had one concussion, I’m a little more cautious.”

The pre-participation physical exam

While injuries in sports are unavoidable, certain preventive measures, such as the athletic pre-participation physical exam, can help prevent sports related injury and death by identifying medical and orthopedic problems that may place the athlete at risk for injury or illness. The PPE also helps schools meet risk prevention and liability requirements.

The New Mexico Activities Association, a nonprofit organization that regulates interscholastic programs for junior and senior high schools in New Mexico, and Las Cruces Public Schools requires that students who participate in interscholastic athletics complete the PPE, said LCPS Athletic Director Ernest Viramontes.

The PPE includes a record of prior injuries, prior surgeries, any heart conditions and the medical history of the athlete, as well as vision screening, vital signs, orthopedic exam and physician clearance.

“Our No. 1 priority in our district is always the safety of the student athlete,” Viramontes said. “The whole process starts with making sure all the student athletes get a sports physical and when injuries do occur, it’s good to have the proper person addressing the injury and the student doesn’t come back to play until they’ve been cleared by the head athletic trainer or the doctor, depending on the injury.”

However, because the typical PPE usually only lasts about 10 minutes, David Gallegos, southern representative for the NMAA Sports Medicine Advisory Committee and deputy CEO of Southwest Sport and Spine Center, aims to provide a more in-depth physical and higher level of health care for young athletes through the Ultimate Sport Physical, an annual event that has grown over the years.

This will be the 10th year Southwest Sport and Spine Center, an outpatient physical therapy clinic, will host the Ultimate Sport Physical, which will take place from 8 a.m. to 1 p.m. Saturday, April 30, at Arrowhead Park Early College High School, 3600 Arrowhead Drive. The event provides middle school and high school student athletes with the required PPE and includes concussion screening, cardiac screening, breathing assessment and orthotics, as well as on-site physicians and athletic trainers who can address any found problems or risk factors. Other organizations and resources relevant to health will also be available to help educate students on things such as staying hydrated, proper nutrition and other teen health concerns.

“We need a physical to address a lot more, because (the 15 to 24-year-old age group) is the only age group that has an increasing mortality rate — their behaviors are risky…so we said, let’s address that, let’s do the physical because we have to do that, and if that’s the only time kids ever see the doctor, then let’s make that time extremely valuable,” Gallegos said.

The Ultimate Sport Physical can accommodate up to 250 kids, with each receiving about 90 minutes of time, with the amount of staff the community volunteers, Gallegos said.

“Memorial (Medical Center) does primary care, MountainView (Regional Medical Center) does cardiology and orthopedics, Southwest Sport and Spine does the physical therapy, the local high school athletic trainers do the athletic training, UTEP (University of Texas at El Paso) does the concussion lab and NMSU (New Mexico State University) does screening for injury prevention,” he said.

Gallegos said having physicians and athletic trainers on-site during the event ensures that students get any medical problems they may have evaluated immediately, at little cost.

“If we find something, we need all the people that (the student) would normally go to, to handle it right then, because it would be of no value for me to say ‘yeah you have a heart problem, go see a cardiologist — they charge you $200 dollars, you’re never going to go. But when it’s all included, it’s all part of the ($20) fee, then you leave (the event) with all your answers taken care of.”

The Ultimate Sport Physical will also address the three most common causes of death in athletics, which are head, heart and heat conditions, Gallegos said.

“We haven’t had anybody die in this state in the last three or four years in sports,” Gallegos said. “The last person who died, it was due to a heart condition and previous to that, it was a brain injury. But in the country, heat kills kids, cardiac issues kill kids and the one what’s become really big in the last two or three years are concussions. So those three things, in terms of serious injury prevention, have to be managed tight.”

Concussions

The Ultimate Sport Physical aims to prevent head injuries by providing concussion baseline testing and teaching parents what is normal and what may be a sign or symptom of a concussion, Gallegos said.

Students who attend the event can also get concussion counseling, said Dr. Dolores Gomez, a faculty member at the Family Medicine Residence Program at MMC and one of the physicians participating in the Ultimate Sport Physical.

“A kid who has had history of traumatic brain injury from a concussion can get counseling at the event, because they are going to be able to understand what that means from the previous injury, and what can happen if they get another concussion when they get back on the field,” Gomez said. “… We know concussions not only cause problems at the time of injury, but have future ramifications, and that is where the concern is.”

While a single concussion should not cause permanent damage, a second concussion soon after the first one, even if not severe, can be deadly or permanently disabling, according to the American Association of Neurological Surgeons.

“The number of concussions can vary (each year), but you’ll find concussions in every sport from basketball to football to soccer to cheer to volleyball,” said Tracie Stone, head athletic trainer at Mayfield High School.

According to the Centers for Disease Control and Prevention, high school football accounts for 47 percent of all reported sports concussions, and 33 percent of all sports concussions happen during practice, Gomez said.

Since August, Gallegos said he has seen one middle school student, seven high school students and one college athlete come to Southwest Sport and Spine Center with a concussion.

According to state law signed March 4 by Gov. Susana Martinez, school athletes who get a concussion are not allowed to participate in sports or other athletic activities for a minimum of 10 days, or until they are completely asymptomatic.

According to CDC, common signs and symptoms of a concussion include:

  • Headache
  • Confusion
  • Difficulty remembering or paying attention
  • Balance problems or dizziness
  • Feeling sluggish, hazy, foggy or groggy
  • Feeling irritable, more emotional, or “down”
  • Nausea or vomiting
  • Bothered by light or noise
  • Double or blurry vision
  • Slowed reaction time
  • Sleep problems
  • Loss of consciousness

“Last year, we did 250 concussion exams (during the Ultimate Sport Physical) and found three kids that were currently in a concussion,” Gallegos said. “They had had it in the last few weeks, they had not recovered yet. So those kids, had they not come (to the event), could have in theory gone on to play again and gotten a second concussion.”

Heart and heat

Dr. Scotty Smith, a cardiologist at MountainView, said he provides cardiology support at the event and screens for possible heart conditions by examining the athlete and looking at an EKG, or electrocardiogram, which records the heart’s electrical activity and can detect things like heart attacks, arrhythmias, heart failure and other disorders that affect heart function.

“It’s very rare, but when people do have certain congenital heart diseases that have not been diagnosed before, then they are at risk of having problems,” Smith said. “It’s a very rare circumstance, but when it does happen, the results are very awful consequences.”

About two-thirds of the time, sudden cardiac death in young people is due to a heart abnormality, according to Mayo Clinic.

To prevent heat illness or heat stroke, Gallegos said students who attend the Ultimate Sport Physical will be given information on proper nutrition and staying hydrated.

All LCPS coaches and head athletic trainers have to go through training with the school district on concussions and heat index training, Viramontes said.

Viramontes said while the basic sports physical is required, anytime students can get extra preventive health care, the better.

“(The Ultimate Sport Physical) brings forth a team effort in terms of the care of the athlete, which I think is extremely important,” Gomez said. “These are young adolescents who are usually very healthy, so it’s rare to find something, but if you’re going to find something, you can definitely prevent something that could happen catastrophically.”

To register for the Ultimate Sport Physical, visit swsportandspine.com. For information about the event, contact David Gallegos at 575-521-4188 or david@swsportandspine.com. The $20 fee will be donated back to any organization or school of the student’s choice. Space is limited.

Alexia Severson may be reached at 575-541-5462, aseverson@lcsun-news.com or@AlexiaMSeverson on Twitter.

If you go

What: Ultimate Sport Physical

When: 8 a.m. to 1 p.m. Saturday, April 30.

Where: Arrowhead Park Early College High School, 3600 Arrowhead Drive

Cost: $20 donation

To register: Visit swsportandspine.com. Space is limited.

Info: Contact David Gallegos at 575-521-4188 or david@swsportandspine.com

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Secondary School

Utah Athletic Trainer Provides Concussion Education

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March kicks off the beginning of spring and is also National Brain Injury Awareness Month. Warmer temperatures mean tree blossoms, green grass and a full array of high school spring athletic programs. While high school sports give young athletes opportunities to shine, they also bring opportunities for head injuries.

“I’ve seen a least one concussion with every sport at the school,” said Melissa Mendini, an Intermountain-employed, certified athletic trainer at Cedar High School. “The highest incidence of concussion is found in contact sports such as football, wrestling and soccer, but it also occurs in cheerleading, track, tennis and baseball.”

Concussion, also scientifically referred to as a mild traumatic brain injury (MTBI), is the result of a jolt or blow to the head strong enough to cause physical, cognitive and/or emotional symptoms. Occasionally concussion may cause short-term unconsciousness. It is the most common, and usually the least serious, type of brain injury. Complications and further brain injury may arise with repeated concussions.

“Concussion symptoms are subtle and sometimes difficult for an untrained eye to see,” said Mendini. “Every Washington and Iron county high school has an Intermountain athletic trainer who attends all games and practices. Athletic trainers are around the athletes all the time. They get to know them personally, and it is easier to recognize concussion symptoms especially when it affects personality.”

Common concussion symptoms may include: headache, dizziness, disorientation, blurred vision, irritability, vomiting, extreme emotions, balance issues, difficulty concentrating and a general sense of not feeling right. Most of these symptoms, aside from a few more obvious ones, need to be self-reported by the athlete. This is why athlete and parent education about MTBI is essential and routinely given by in-school athletic trainers.

“Anytime that concussion is even suspected,athletes are immediately taken out of play,” Mendini said. “Athletes with concussion are at risk for further concussion and worsening symptoms should they remain in the game. No game is worth a child’s health.”

Rest is the true treatment for concussion. Mendini also recommends eating well and staying hydrated to ensure proper nutrients for healing. Cognitive rest, or reducing activities that require concentration, is also an important part of the healing process.

“Athletes with concussion need to rest physically and mentally,” Mendini said. “Rest includes staying away from video games, TV, computers, texting, and even homework, as these activities may exasperate symptoms.”

With proper rest, concussion or MTBI symptoms usually subside in a few days or weeks. When all symptoms are gone, an athletic trainer will then allow the athlete to resume practice and game play. Athletic trainers have expert concussion training and will also refer athletes to other medical professionals if symptoms deteriorate.

“Proper-fitting, newer, sport-specific headgear really does help prevent head injury,” Mendini said. “Helmets should be routinely inspected for cracks or signs of excessive wear and replaced as necessary. As always, following the rules of play and using good sportsmanship also help prevent concussion and other injuries.”

Certified athletic trainers are positioned in every high school throughout southern Utah to assist and improve the health and wellness of high school athletes. Athletic trainers also support and treat common sports injuries such as concussion. Having certified athletic trainers in each high school is a win-win situation for schools, athletes, and parents.

This LiVe Well column represents collaboration between healthcare professionals from the medical staffs of our not-for-profit Intermountain Healthcare hospitals and The Spectrum. Contact 435-251-2108 for information.

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Amateur Sports

Oklahoma State Intramurals Adds Concussion Policy

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Austin Dick locked onto his target, a football thrown over the middle and dropping toward him.

The Oklahoma State management senior said the details are all secondhand because he has no memory of the event.

As he moved up on the ball from his deep safety position, he didn’t see the receiver or his teammate on a collision course with him.

The lights went out. Violently.

“All I remember is them hiking the ball, and then I remember waking up with four or five (EMTs) surrounding me, and I had no idea what happened,” Dick said. “They were asking me if I knew what day it was, or where I was at, and I couldn’t answer any of those questions.”

The game stopped when Dick’s face smashed into his teammate’s ear. The collision knocked him to the ground as his concussed brain settled in his skull. When he came to, he said nothing was as it seemed.

“I laid there for a while, called my mom,” Dick said. “I was still really out of it not knowing what was going on. I remember looking over at my friend who I hit and his ear is gushing blood, and I’m like, ‘How’d you get hurt?’”

Dick said he was able to walk to a car for a ride to the emergency room and recovered in just over a week. He said he returned to the field a month later.

University of Tulsa’s director of athletic training said intramural concussions are a genuine concern, namely with when players can return to the field. Ron Walker, also a clinical professor at TU, said when testing for concussions, athletic trainers will use cognitive tests compared with predetermined base scores for a given player.

If a player scores lower after a hit to the head or shows obvious signs of a concussion, he or she is pulled from competition. A player is cleared to return only when he or she achieves the same cognitive marks as before, Walker said.  He said the criteria are important not only to show progress, but also to keep players in check.

“Waiting for a participant to self-report is like asking a drunk if they want another beer,” Walker said.

He said it’s the time immediately after a concussion when the risk is greatest for serious injury, often when someone has the common symptom of a headache.

“If someone sustains a second concussion while they still have that symptom, they’re at a significant risk for even a fatal injury; it’s called second-impact syndrome,” Walker said. “When there’s no athletic trainer, it’s common sense recognition of that being a possibility.”

OSU’s assistant director of recreational programs said the department implemented a concussion policy in January, and two students have already gone through the protocol for suspected concussions.

Jason Linsenmeyer said supervisors are trained to spot concussions and given specific protocols for when players can return to playing sports or attending classes.

“If there’s a suspected concussion based on these signs my supervisors have been trained on, they’re going to pull the individual out,” Linsenmeyer said. “Any of those individuals that are pulled out for a potential concussion have to go seek medical attention before they’ll be allowed to play intramural or club sports again.”

Linsenmeyer said supervisors receive training on concussion protocols, and officials have a card listing signs and symptoms of concussions on their person. But he also said those watching aren’t medical staff.

“It’s just our staff as far as officials and supervisors; sometimes our graduate students go out there, but none of them are athletic trainers, none of them are any of the advanced medical training certifications,” Linsenmeyer said.

Although tracking concussions is a good start for any intramural department, it depends on who’s monitoring players, Walker said.

He said although referees or supervisors can act as monitors, they’re focused on the rules and the fair play of a game, not specifically any signs of a concussion. Ideally, an athletic trainer can observe participants because otherwise some less-obvious concussions might be missed.

“From an injury surveillance standpoint, yeah, it’s certainly going to be hard to track,” Walker said. “When they have an incident and there’s a report filed, I would think that if the reports reflected that participants have concussions, I would think those would only be the most severe cases, which would be in the minority.”

Linsenmeyer said because the undergraduate athletic training program was moved to an OSU-Tulsa graduate program, there isn’t a viable way to have medical staff observe.

“There’s really no avenues here to get athletic trainers,” Linsenmeyer said. “Obviously, those are expensive. We have lots of events; we have 50 plus events that we offer every year.

“Trying to staff an athletic trainer or someone who’s got advanced medical certifications, that budget would go out the roof just for basketball, same thing for flag football. … Trying to provide that would be a nightmare as far as budget concerns. We just don’t have that available. ”

Walker said even if officials monitor for concussions, they should be trained enough to provide the rising standard of care for intramural sports.

“There’s absolutely no reason for intramural departments across the country to not accept (concussion training) as a standard and require that for their intramural officials and game managers,” Walker said.

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