In an AP article from ABC it was reported that “nearly a fifth of 160 NFL players asked said they hid the effects of concussion.” If you talk to college and other school aged athletes in all sports you would likely find a similar sentiment. Athletes love to compete and if they do not fully understand the implications of playing with a concussion, (and sometimes even when they do) they will try to “play through it.” This issue is even more acute for athletes who are at risk of not making the team or who perceive some risk of losing their spot on the team. If you add this group of athletes who are reticent to report concussion to those who are unable to, either because they are too confused or do not recognize the symptoms, you have a significant number of athletes that are at risk of a second, possibly debilitating, concussion.
In order to increase the likelihood that those who have suffered a concussion are quickly identified the NFL “wants players to keep tabs on each other and tell their teams if they believe someone else has a head injury” according to the ABC report. This kind of front line peer support is essential in the process of keeping athletes safe from the cumulative effect of repeated concussion over a short period of time. An athlete with a suspected concussion that is indentified by his/her teammates can be evaluated by someone trained in concussion management and the proper disposition can be achieved. The athlete may be fine and can return to the game or she/he may need to sit out for further evaluation.
If the process of using teammates to help indentify athletes who may have sustained a concussion is going to be effective there needs to be a process in place to educate players about concussion. The CDC has some helpful information to assist in the process, but it also requires that coaches and other athletic staff take this problem seriously. If everyone who is involved in athletics understands the signs and symptoms of concussion we can make second impact syndrome and other serious consequences of repeated concussion within a short period of time a thing of the past.
Half way through the second half of a game, Carol the star forward on the girls soccer team jumps to head the ball and collides solidly with a defender from the other team.The girls both fall backward and Carol strikes her head on the ground.She reaches for her head and as the other girls gather around her the coach comes onto the field.After a few tense minutes Carol gets up and walks off.She is slightly unsteady on her feet, but she makes it unassisted to the sideline where she sits on the bench holding her head.It was clear to Carol’s coach, and others who were there, that Carol had suffered a concussion, and there was no question of her returning to the game.
As straight forward as this situation seems, there are still many questions that need to be answered.Does Carol need to be taken to the emergency room to be evaluated?Does she need a CAT scan?Should she go back to school right away?Will she be able to play in the big game next week?These questions are less straight forward, and having some objective data can help.Objective test data can make these important questions more manageable and can increase the likelihood that the right decisions will be made.
The decision about the emergency room will depend on the symptoms and the availability of medical professionals who can evaluate Carol, but if there is any question that it could be something more serious than a concussion a visit to the ER is probably indicated.The ER staff will make the call about the CAT scan.However, CAT scans, while useful in moderate and severe head injuries, are not helpful in the diagnosis and treatment of concussion.
The decisions about returning to school (or work) and returning to play are more complicated and require a good understanding of all of the symptoms of concussion.Fortunately there are tools to help evaluate the seriousness of concussion, and none is more widely used than ImPACT – mandated in the NHF and NHL and used extensively in professional, college and high school sports.ImPACT is a computerized test that takes about 30 minutes to complete and measures mental abilities that have found to be affected by concussion.
In my opinion one of the best features of the test is the ability to gather information on athletes before they are put at risk for concussion – a kind of pre-testing (or baseline testing as we call in the professional arena).In sporting organizations where the test is systematically used, all of the athletes are pre-tested at the start of the season.This pre-testing establishes what is “normal” (baseline) functioning for players.If a player subsequently suffers a concussion, he/she is re-tested and a comparison of the two tests provides information about how serious the concussion is.Over time, as the post-concussion results look more like the pre-test (baseline) results we have some confidence that the athlete is recovering from the concussion.
In Carol’s case, if she had taken a pre-test, we could retest her and know how serious the concussion is and if we need to keep her out of school.As she is re-tested over time the test results can be used to help make the decision about how soon she should return to normal activity including school, exercise and soccer.
Another advantage of pretesting is that the process itself leads to a greater understanding among the players, the coaches and the parents about the signs and symptoms of concussion.The better everyone understands concussion the greater the likelihood that athletes who suffer concussion can be managed appropriately.The consequences of mismanagement can be devastating.Athletes who have suffered a concussion are at higher risk for serious injury if they experience another concussion before the first concussion has resolved.In rare cases, young athletes have died from second impact syndrome and others have suffered long-term impairments in functioning that could have been avoided if their initial injury had been handled correctly.
At the Center for Human Potential we are committed to educating athletes and their families about concussion and concussion management.We are also committed to making baseline testing available to all who are interested.We are so committed to the importance of baseline testing that we offer it for free to those who work for companies that we provide EAP services for (e.g., Overstock.com) and their immediate family members.
