No Longer Clueless About
Concussions
It's first and ten, and the football is on the 20-yard line.
The quarterback, a high school senior, takes the snap, looks for an open
receiver...and is leveled by a bone-crunching tackle. His head slams against
the ground and he sees stars. Shaking off dizziness, he slowly rises to
his feet as the crowd cheers. A minute later, he's back in the huddle, attempting
to call another play. Unfortunately, he can't remember what play to call.
What's wrong with this picture? The player in question sustained a concussion and should not have continued playing. Unfortunately, no one on the sidelines or the field knew how to spot the signs and symptoms of a concussion.
Now, however, a new program is available to help New Jersey's coaches, trainers and team physicians evaluate sports-related head injuries. "Prevention of Concussion in Sports" was developed by Jill Brooks, PhD, clinical neuropsychologist at UMDNJ-Robert Wood Johnson Medical School. Brooks developed the program as a result of treating athletes with concussions in her practice. The program was launched in September, 1997 at Bernards High School with the football team, and was expanded this winter to include the wrestling, ski racing and cheerleading teams. Eventually, it is hoped that the program will be made available to all New Jersey high schools.
Some 10 percent of all college football players, 20 percent of all high school football players and 5 percent of soccer players sustain concussions during play, according to the Brain Injury Association. A concussion results from the brain shaking inside the skull, and does not require a direct blow to the head. Contrary to popular belief, an athlete does not have to suffer loss of consciousness to have a concussion.
When a student athlete sustains a head injury, it is difficult to determine how serious it is. Players with concussions don't limp off the field. There is no visible blood or trauma. But there are specific symptoms that signal something is wrong. These include headaches, dizziness, disorientation, nausea and vomiting. "It's important to recognize the signs of concussion right away," says Brooks. "If someone suffers a concussion, goes back into the game and has another hit to the brain, it can be catastrophic."
To evaluate the grades of concussions right on the sidelines, coaches, trainers and team physicians carry pocket-sized laminated cards containing the information in the chart below. A quick check of the card helps them determine whether an injured player should sit out or return to the game.
Another important aspect of the program is the Sideline Assessment of Concussion (SAC), which includes tests of orientation (asking player to state the time, place and date), concentration (saying a series of numbers or months of the year) and verbal list learning. All athletes are pretested before the season starts, providing baseline scores that are recorded. The SAC scores at the time of concussion can then be compared with the baseline scores.
"This program really opened my eyes about concussions and the damage they could cause," said Bernards High football coach Richard Tramaglini. "I knew head injuries could be serious, but I didn't realize there were different levels of concussions, or that recurrent concussions could be dangerous. Before the program, we really had no way of knowing if an injured player sustained a concussion. Now we do."
The coach was also surprised at the extent of head injuries. Seven team members sustained a total of eight Grade 2 concussions during the football season. One player, Mark McDonald, sustained two concussions. "It was very clear from Mark's injuries that he had to change his tackling technique," says Brooks. "His concussions were a result of spearing, or leading with his head, in making tackles. He learned to lead with his shoulder instead." After one head injury, Mark's sideline assessment score was significantly lower than scores on the baseline test he took the previous summer. Because of the "Prevention of Concussion in Sports" program, his coach and trainer knew that he needed to sit out until his concussion had resolved. At another school, he might have gone right back into the huddle.
| GRADE OF CONCUSSION |  | RECOMMENDATIONS |
| GRADE 1 Symptoms resolve in less than 15 minutes with no loss of consciousness |
|
Remove from game; examine immediately and at 5 minute intervals. Can return with no loss of consciousness to game if symptoms clear within 15 minutes. |
| GRADE 2 Symptoms last more than 15 minutes with no loss of consciousness |
|
Remove from game; should not return to play that day. Should receive a neurological with no loss of consciousness examination to clear athlete to return to play after 1 full asymptomatic week. |
| GRADE 3 Any loss of consciousness |
|
Take by ambulance to the nearest emergency room if still unconscious or if severe symptoms persist. Should receive a neurologic evaluation to clear athlete to return to play after 2 weeks to 1 month. |