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Neal McGrath

Concussion care for student-athletes

By Neal McGrath
December 30, 2009

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THE National Football League is finally showing signs of taking significant steps to better address sports-related concussions, as research continues to show that improper concussion management may lead to permanent brain impairment.

But what about student-athletes? Studies show that 5 to 10 percent of student-athletes in high-contact sports (football, hockey, soccer, and wrestling) will sustain concussions each season. There will also be a significant number of concussions occurring in many other sports, due simply to accidental collisions.

Many have traditionally thought of “having your bell rung’’ or “getting dinged’’ as an injury that will clear up quickly and does not require much medical attention. Some athletes are simply told to take a week off from the sport without follow-up. Others never report their symptoms and keep playing, sustaining further brain trauma. These students may take months to recover and some will suffer longer-term symptoms if they are injured again. In rare but tragic cases, another blow too soon can result in a more severe disability or death.

There is reason for optimism, though. Due to awareness raised by the media, advances in clinical assessment and treatment, and implementation of sports concussion management programs in a growing number of schools, we are beginning to see progress for student-athletes.

Those who suffer from concussions tend to recover well if the injury is identified immediately, if the athlete does not sustain repeated blows, and if the student is supported in temporarily cutting back on cognitive demands in school to allow proper rest until recovery is complete - usually in days to weeks. These “ifs’’ are manageable when athletic staff, team physicians, student-athletes, school nurses, teachers, guidance counselors, and parents understand these basics and work together.

Moving forward, there are four major areas to be addressed by school committee and athletic department policy:

Concussion education. Athletic trainers and school nurses are the professionals who manage these injuries day-to-day. They need to have up-to-date knowledge about concussion recovery. Student-athletes and coaches must learn the basics of concussion identification and management and appreciate the risks of returning to play too soon. And parents need to know how a concussion may affect their son or daughter both as an athlete and as a student.

Neurocognitive evaluation. Even at the high school level we now have access to the same computerized neurocognitive testing used by professional teams. This testing is affordable, can be done online at school, and gives invaluable information to athletic trainers and physicians about an injured student’s readiness to return to play.

Academic support during recovery. Students may need temporary accommodations in their school work to help them keep pace as best they can while making a full cognitive and physical recovery. Teachers and guidance counselors can make a tremendous difference if they understand concussions and work flexibly with these temporary learning disabilities.

Return-to-play guidelines. Athletes should not practice or exercise while still symptomatic. They should never resume contact action until they are fully symptom-free, have cognitive test results that are back to normal, and receive medical clearance by their personal physician and athletic department. Every school should have written guidelines that are understood by athletes, coaches, and parents and that support athletic trainers and their team physicians in making safe return-to-play decisions.

Sports are a major part of life for so many children. Concussions are a serious, but manageable risk in our sporting society. Some schools in the region have taken strong steps in concussion management, but many more have yet to follow.

Neal McGrath is a clinical neuropsychologist in Brookline and director of Sports Concussion New England.

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