Piper Reasoner smiles as she asks a series of questions to a student in the training room at Legend High School.
“What is your name?”
“Are you nauseous?”
“Am I in focus right now?”
Minutes earlier the boy, 17, was elbowed in …
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The “return-to-learn” and “return-to-play” protocols employed by the Colorado High School Activities Association are credited with reducing the severity of brain injuries from concussions among high school athletes. Here are some of the guidelines:
Return to learn
Most students with concussions should stay home for one to three days after the injury. If symptoms are severe, the student athlete should be on bed rest and avoid texting, video games, computers, TV and homework.
When symptoms are tolerable, manageable and intermittent for 30 to 45 minutes, the student athlete can be back at school with support from the school.
The school should help the student understand that limiting academic and extracurricular activities for one to four weeks is necessary for good concussion recovery.
Coaches, guidance counselors, school nurses, administrators and other staff should all communicate to ensure the best outcome for the injured student athlete.
Return to play
An athlete should be symptom-free before being allowed to start the graduated return to play. This means an athlete must be functioning at 100 percent of pre-concussion levels academically and at home before returning to athletic activity.
School staff, coaches, guidance counselors, administrators should maintain communication and work closely with parents to monitor the student athlete’s progress.
All athletes should be put through a progressive and graduated return to play protocol, beginning with light exercise and working their way back to full participation.
Returning an athlete who is still symptomatic to physical play increases the risk of “Second Impact Syndrome,” in which an athlete is still symptomatic from a concussion and sustains a second impact that can result in serious brain damage or death.
Source: CHSAA Sports Medicine Handbook
Immediate treatment is the best way to rule out a concussion or learn what to do to minimize damage from the injury. A parent or guardian should call 911 if they see any of the following symptoms in a child:
• One pupil is larger than the other.
• Drowsiness or inability to wake up.
• A headache that gets worse and won’t go away.
• Slurred speech, weakness, numbness or decreased coordination.
• Repeated vomiting or nausea, convulsions or seizures, shaking or twitching.
• Unusual behavior, increased confusion, restlessness, sadness or agitation.
• Loss of consciousness — even a brief loss of consciousness should be taken seriously.
Signs and symptoms of concussions in toddlers and infants:
• Any of the signs and symptoms listed above.
• Child will not stop crying and cannot be consoled.
• Child will not nurse or eat.
Other signs a child may have suffered a concussion or brain injury:
• Child can’t remember events prior to or just after a hit or fall.
• Child answers questions slowly.
• Child moves clumsily or awkwardly or displays double or blurry vision.
• Child complains of headache or “pressure” in head.
• Child is bothered by light or noise.
Source: Centers for Disease Control and Prevention
As ongoing research shows the seriousness of concussions, many long-held notions about the condition are being dispelled. Here are some misconceptions and facts regarding concussions and treatment:
• A player knocked unconscious will suffer a worse concussion than a player who didn’t lose consciousness.
Any contact that causes rapid movement of the head can cause a concussion. Minor collisions can be as serious as a blow that knocks out a player. In addition, several low impact blows may be more dangerous than a single collision of great force.
• Male athletes sustain more concussions than females.
Symptoms tend to be more physiological with males (loss of balance, clumsiness) and more psychological with females (fatigue, confusion) but injuries occur at comparable rates.
• Concussions are the same for adults and adolescents.
Adolescent brains are still developing, and concussions can have longer-lasting and more dramatic effects when sustained by children or young adults.
• An athlete who has had one concussion is more likely to have another than an athlete who hasn’t been concussed.
The threshold for sustaining a concussion is diminished once a player has had a single concussion. This makes it easier to suffer subsequent concussions, especially if a player suffers another concussion before fully recovering from a previous one.
• Concussions should be treated and managed on an individual basis.
All brains are different, so there is no one “right” way to treat concussions. Coaches and school staff should assess student athletes’ “baseline” for behavior and cognitive performance in order to recognize when they are not performing up to that level, as well as when the student has fully recovered and is back to normal following a concussion.
• Whenever a student is suspected of having a concussion, it should be treated as one until proven otherwise.
Symptoms can vary and aren’t always immediately apparent. If an athlete sustains a blow that looks like it may have caused a concussion, it should be assumed that the he or she has one.
Source: Science Daily
Minutes earlier the boy, 17, was elbowed in the head during basketball practice. A friend walked him to see Reasoner, Legend’s head athletic trainer. Dr. Kathy Vidlock, volunteer physician for the Parker school's football team, marks a clipboard after each of his responses.
The boy correctly repeats a series of three numbers back to Reasoner, but he can’t do the same when she gives him four digits to recall. She then guides him through a series of physical assessments, not unlike a roadside sobriety test. The boy manages to stand with his eyes closed, touch his nose and maintain his balance.
Reasoner sends him back to class, but not practice. She rates his concussion below a 1 on a scale from 1 to 5, with 5 being the most severe.Nonetheless, she will check in with him almost daily for a couple of weeks.
The slow, careful examination and follow-through highlights the caution that concussions are now treated with in Colorado schools. After years of studies and stories about concussions and professional athletes, a thoughtful and careful approach to the condition is now in place for school staff, athletics administrators, parents and students.
“They’re usually 10 percent of the injuries we deal with,” Reasoner said, “but they take 90 percent of our time.”
‘I got scared’
One of the students Reasoner has spent a lot of time with is Grayson Engel, 17. Now a junior at Legend, Grayson suffered a concussion as a freshman playing on Legend’s football and rugby teams.
During rugby practice in April 2015, Grayson’s head was sandwiched between the other players’ heads as they collided. He didn’t black out, but he fell over and “really zoned out.”
“My teammates had to explain what happened,” he said.
His mother, Teresa, took Grayson to an urgent care facility that evening and became worried as he turned pale and failed the tests the doctor administered.
Teresa’s concerns were compounded by seeing media reports about concussions among NFL players, and managing a call center for clinics that treat college and professional athletes with brain damage.
“I got scared,” she said. “How bad does it have to get for there to be consequences 20 years later?”
Return to play, return to learn
Over the last decade, the national discussion on chronic traumatic encephalopathy or CTE — a progressive degenerative disease of the brain found in people, many of them athletes, with a history of repetitive brain trauma — and the risk of long-term brain damage from concussions has grown louder.
A study by neuropathologist Dr. Ann McKee found 110 of 111 brains of National Football League players had CTE. The results of her study were published in July in The Journal of the American Medical Association. And the National High School Sports-Related Injury Surveillance Study, generated by the Center for Injury Research and Policy, reported that concussions accounted for almost 25 percent of all injuries sustained by high school athletes in the 2014-15 school year.
According to Bert Borgmann, assistant commissioner of the Colorado High School Activities Association, discussion about how to best handle head injuries has already been underway in Colorado schools.
“Some of (the NFL’s) research had already been going on at the high school and college level,” Borgmann said.
High school and college athletic programs were training coaches and athletes to prevent head injuries, but after seeing data on long-term effects from concussions, including CTE, CHSAA and its affiliates revised guidelines to ensure students are fully recovered before returning to classrooms and locker rooms.
“What’s even more important is almost every school district in Colorado now has return-to-learn protocols,” Borgmann said.
Fluorescent lights, computer screens and cognitive activity can all aggravate concussion symptoms. As such, any student who has suffered one must be cleared by a physician before returning to school. Further evaluation and clearance is typically required before returning to light exercise and, eventually, playing time.
Taking it seriously
Football causes the majority of concussions in high school sports, according to Reasoner, Borgmann and Vidlock. But students get concussions from soccer, cheerleading, skateboarding — even falls in the classroom — and they all go through the same process to return to school and sports.
“You can’t use your phone, you can’t watch TV,” Grayson said. “The majority of the day consists of sitting around and sleeping.”
Grayson waited a few days before returning to class, but it was three weeks before he did any assignments or light exercise with his rugby teammates. Six weeks after the injury he hit the rugby field again, just in time for the last game of the season.
The process was frustrating for him, but reassuring for Teresa.
“I remember feeling assured that the school was taking it so seriously,” Teresa said. “I was impressed that everyone was following the protocol to a T, no one was pushing him.”
Grayson kept his spot on the rugby team but quit playing football. Schoolwork and a part-time job were his primary reasons. But he watches the news, too.
“I’ve definitely seen all of the stuff about CTE,” he said. “This opened my mind that it can happen to anyone.”
More than a bell
By their competitive nature, athletes tend to “walk it off” when injured, but it’s not unheard of for coaches or parents to urge players back onto the field, court or ice too soon. Data on concussion risks and outcomes has been increasingly available over the last decade, but changing a culture can take generations.
But Vidlock says it’s happening, and she’s seen the difference firsthand.
Playing on herfirst-gradebasketball team, Vidlock was concussed when a ball hit her in the face. Her coach’s response: “Get back on the court.”
An atmosphere of “positive coaching” has replaced playing through the pain in the years since her own experience, and Vidlock said the coaches and staff members she works with look out for their players’ health. Students like Grayson may grow impatient waiting to return to their favorite activities, but nearly every parent Vidlock has worked with appreciates the process, she said.
Parents, school staff and students are now on the same page, Vidlock said.
“Now there’s communication between physicians and trainers, school nurses and teachers and school psychologists and guidance counselors,” she said. “There used to be this feeling that it isn’t a concussion, they just ‘got their bell rung.’ Getting your bell rung is not a medical condition.”
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