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Training young athletes to take concussions seriously

It's a no brainer

Tuesday, September 18, 2007

By Meg Nugent
Star Ledger Staff

Student athletes at East Brunswick High School are required to sign a “player's contract” to ensure that teammates will keep an eye out for each other.

Number 2 on the list of five rules, printed in big black letters a sheet that hangs in the locker room, deals with concussion:

If a teammate appears to be dazed, “foggy,” disoriented or “out of it,” I will speak with my athletic trainer or coach as soon as possible. I know that allowing a teammate to play with a possible concussion is extremely dangerous and may cause serious harm.

Phil Hossler included the concussion clause when he wrote the contract because his years as a certified athletic trainer at East Brunswick High have taught him this about teenage athletes: When it come to getting a head injury while playing a sport, they tend to lie about it.

“They lie because they're motivated—they want to play,” said Hossler.

In Chatham Borough, the Chatham Athletic Foundation is providing funding for kids ages 10 and up who are enrolled in the borough's recreational sports programs to take part in a computerized concussion evaluation system.

Known as ImPACT (Immediate Post-Concussion Assessment and Cognitive Testing), the 20-minute test measures functions such as brain processing, memory and visual motor skills. It is taken pre-season to establish baseline data about an athlete's neuro-cognitive abilities. The, if the athlete is suspected to have suffered a concussion during the playing season, he or she is retested and those results are compared with the pre-season data.

With a new season underway for school and recreational sports, measure such as Hossler's contract and ImPACT exemplify a more aggressive approach on the part of athletic sports medical professionals to get kids, their coaches and parents to take concussions more seriously or risk potentially lifelong cognitive, physical or emotional damage and, in some cases, death.

“Many times, kids do downplay it or hide it from their parents, coaches or athletic trainers, and that can be potentially a big problem,” said J. Christopher Mendler, a sports medicine specialists for the Sports Medicine Institute at Saint Peter's University Hospital in New Brunswick.

“They're young and they have that idea that nothing bad is ever going to happen to them. They don't think through the potential consequences of an unreported head injury.”

An estimated 1.5 million sports-related concussions occur each year, according to the Centers for Disease Control and Prevention, and it's considered the most common brain injury in sports, according to Hossler, who co-wrote the book “Getting A-head of Concussion: Educating the Student Athlete's Neighborhood’ (Lash & Associates Publishing/Training Inc., $20).

Still, misconceptions about concussions persist and they fuel the idea that they really aren't that big a deal.

“The biggest misconception is that most people think, if they haven't lost consciousness, they probably don't have a concussion,” said Barbara Geiger-Parker, executive director of the Brain Injury Association of New Jersey, which for the past two years has awarded matching grants to high schools interested in using the ImPACT program for athletes.

“It's that, ‘Gee, if I'm walking and talking and still eating supper, I must be okay’ kind of thing,” said Hossler.

You don't need to lose consciousness to have a concussion. In fact, you don't even need to sustain a blow to your head to have one, according to Mendler. “A concussion can occur if you're hit directly on the head, but it can also happen if there's a blow to the body where the head gets shaken back and forth and the brain can bounce off the skull.”

Most people don't understand that a concussion is a brain injury, Hossler said. “How many times do you want to injure your brain? How many times can you injure your brain until something permanent happens?”

In the medical world, the term “concussion” is often interchangeable with “mild traumatic brain injury,” and it occurs when a blow or a jolt to the head interrupts the normal function of the brain.

Hossler doesn't want the word “mild” to lull anybody into thinking a concussion is a minor event. ”The concussion umbrella is a huge umbrella, and a lot of things fit under it. You might barely fit under that umbrella but, bottom line, you have a concussion and who wants to play with their brain?”

Young athletes need to understand it's important to report any symptoms to concussion they may be experiencing to limit the extent of possible complications.

For example, an athlete who experiences a concussion but returns to play before symptoms have entirely disappeared is at risk of a rare but potentially fatal condition known as “second impact syndrome,” which involves brain swelling and permanent neurological damage.

A more common condition, call chronic post-concussive syndrome, can lead to prolonged difficulties with concentration, academic work or employment-related tasks, memory function and processing information, according to Mendler.

“These can take several weeks or a year or more to resolve,” Mendler said, “and they can occur with single or repeated concussions.”

The time it takes to heal from a concussion can vary greatly and depends on the age of the athlete and the severity of the injury, said Mendler.

Young athletes who experience concussions tend to fare worse than their older counterparts, said Hossler “The adolescent brain tissue is more immature than an adult's brain tissue. Immature brain tissue bruises easier and holds onto symptoms longer.”

The antidote for a concussion is rest. “For the most part, it needs time,” said Mendler. “There’s no specific medicine, no immediate intervention that will quicken the healing process. The body will take care of things, but it needs a chance to do so.”

That means refraining from play until the healing process is complete.

T.J. Marriot, 15, a sophmore and a member of the varsity football team at Chatham High School, has been sidelined since mid-August to recover from two concussions he sustained in the span of three weeks. The first one came during a snow-boarding camp in July but it went undetected until he had a second concussion when he started football practice.

T.J. said his doctor told him that getting tow concussions in such a short time means “my symptoms may last longer and it might take longer for my brain to heal.”

“If you're getting headaches and you don't think something is right with your head, you should definitely get it checked out,” advised T.J. “Sports is a big part of life, but it’s not worth being crippled over.”

Hossler wrote his book to “make people smarter” about the symptoms of concussions so they can more easily identify them and take quicker action in helping the athlete to heal. He also said it's important for everyone in the athlete's “neighborhood”—which includes parents, coaches, athletic trainers, teammates, teachers, the school nurse an doctor— to be informed if a concussion occurs and to understand their particular role in monitoring the athlete's progress during recovery.

“If everyone in that kid's neighborhood knows their role and responsibility, they you’ve got to like the athlete’s chances of getting good care.”

Angela Steward contributed to this article

Meg Nugent may be reached at mnugent@starledger.com or (973) 392-7955.

© 2010 Chatham Athletic Foundation

Email: theboard@chathamathleticfoundation.org