Parents of High School Students
Your son is on the varsity football team, and you are in the stands watching the game. Your son takes a significant hit and the coach pulls him for the rest of the game. After the game, the athletic trainer wants to see you in his office.
What should be the immediate response to an event that may have caused a concussion?
The model policy contains the following protocol to follow when a concussion is suspected in interscholastic sports:
- Immediately remove the athlete from practice or competition. If there is a deterioration of symptoms, loss of consciousness, or direct neck pain associated with the injury, a coach, parent, or guardian should call 911.
- The school’s licensed healthcare provider, who is trained in the evaluation and management of concussion, should evaluate the injured student-athlete.
- School personnel (Athletic Director, Building Administrator, Certified Athletic Trainer, School Nurse, Coach, etc.) should next inform parents/guardian that a concussion is suspected.
- The school should provide the student-athlete with the district’s board-of-education-approved medical checklist and suggestions for management to give to the parent/guardian, physician, and/or other licensed healthcare professional trained in the evaluation and management of concussion.
- The student-athlete must receive written clearance, from a physician trained in the evaluation and management of concussion, which certifies that the student-athlete is asymptomatic at rest and may begin the district’s graduated return-to-play protocol. Medical clearance that is inconsistent with district, charter, and non-public school policy may not be accepted and such matters will be referred to the school/team physician.
What exactly is baseline testing? Is it the same as neurocognitive testing?
The term “baseline testing” typically refers to a brief computerized neurocognitive test that provides information about how an individual performs certain cognitive functions. Some of the computerized programs test for attention span, working memory, sustained and selective attention time, response variability, non-verbal problem solving, and reaction time. Individual programs may have unique testing criteria. Once an individual’s baseline is recorded for these functions, physicians or school personnel can administer a re-test following a suspected concussion (though not immediately following the event) and the software program will compare the scores from the baseline test to the scores from the re-test. There are numerous baseline testing software companies that make baseline testing available to individuals, teams, and other groups.
Baseline testing is just one tool to assist physicians in diagnosing concussions and making safe return-to-play decisions. It is not mandated in New Jersey that student-athletes take baseline tests. A baseline test and subsequent re-tests are not necessary to monitor the progress of recovery from a concussion, however, many clinicians use the tests because of additional information they may provide to assist with return-to-play decisions and academic accommodations. Baseline testing is useful because it is the only objective diagnostic tool available to clinicians who treat and manage concussions.
The computerized neurocognitive test typically used for baseline testing is different from a complete neuropsychological evaluation. A typical complete neuropsychological evaluation takes about ten hours to complete and provides detailed information about an individual’s brain-behavior relationships. A neuropsychological evaluation may become important when the symptoms of a concussion are not resolving and the physician refers to a neuropsychologist for further evaluation.
Should I be worried about my son who has had at least three concussions over the years?
There is no specific number of concussions identified as a cut-off point for playing organized sports. Experts do agree that it is critically important to keep good medical records in a child’s medical history about any concussion that has occurred including information about symptoms, length of recovery, and any concussion experts involved in the child’s recovery. This kind of information can help parents, physicians, and student-athletes determine when sports-related concussions present a risk to the quality of a child’s future and potential to reach his or her academic and career goals.
The main concern about multiple concussions is the potential for long-term effects that can compromise an individual’s quality of life. There is no information available to determine which concussion could be “one too many.” Research suggests that each subsequent concussion takes progressively longer to resolve. Decisions about playing organized sports and decisions about when it is safe to return-to-play are ultimately up to athletes, parents/guardians, and physicians. Having accurate concussion history can help everyone make better-informed decisions. The key point to remember is that each individual is unique and each concussion is unique. Each concussion is a brain injury and should be taken seriously.
The Return-To-Play (RTP) information seems so complicated. How do I know if we are making the right decision?
It takes a team approach to manage a concussion. In New Jersey, Interscholastic sports are structured in such a way that there are well-informed personnel in high schools involved in return-to-play decision-making. Athletic trainers and coaches are required to take concussion training, and the Athletic Trainer’s Society of New Jersey (ATSNJ) has been an active participant in discussions about concussion issues. In addition, each school district in New Jersey is required to have a concussion policy in place that is based on the model policy developed by the New Jersey Department of Education and a team of concussion experts.
The return-to-play protocol included in the New Jersey Model Policy on Concussion was presented at the 2008 International Conference on Concussion in Sport and provides for a student-athlete to move through the protocol over at least a five-day process with exertion increasing each day. A clinician should monitor the protocol to observe whether or not symptoms re-occur at any time during the process. If any symptoms re-occur, the student-athlete must go back to the previous step before proceeding with the protocol. A key to making safe return-to-play decisions is to be certain that the student-athlete understands the importance of reporting any symptoms during the recovery process. Information from the student-athlete, physician, athletic trainer, coach, parents/guardians, teachers and even peers is considered throughout recovery and included in the return-to-play decision making. Training on concussion is available from a variety of sources for each of these individuals; it is important for all individuals working with student-athletes to be well informed and knowledgeable about concussion issues.
The rise in media attention to concussion often comes as a result of a local tragedy, usually a case of second impact syndrome. Second impact syndrome describes an event that results in death or lifelong disability because an athlete sustains a second blow or hit before a concussion is completely resolved. In such instances, the relative severity or lack thereof of the second hit does not seem to be correlated to the onset of second impact syndrome. Research is ongoing to learn more about second impact syndrome, as it seems to be something that only affects adolescents and young adults. The risk of second impact syndrome is one of the reasons why return-to-play decisions are so critical.