Hundreds of studies over the last decade have described sports-related concussion and its relation to post-concussion syndrome and the potential for long-term effects, but high school sports programs are just now plugging into the message from the medical community.
Athletes at Hinsdale Central High School in Chicago’s western suburbs met with the athletic staff at the high school for a half hour after school on March 3. They discussed the rule of thumb that completing an annual physical in June would allow them to be eligible for all three sports seasons. They discussed the school’s code of conduct—things like they can’t use drugs, drink alcohol, or have any unexcused absences from school.
Most important, though, they talked frankly about the need to be honest with themselves and their coaches and athletic trainers when it comes to head injury.
About 12 minutes of the meeting were spent watching a video about an athlete from New Jersey who suffered a concussion during a football game and then a second blow to the head. Now he can barely speak after brain surgeries left him without several parts of his brain.
“My son is the consequence of not understanding the symptoms of a concussion,” the athlete’s mom said in the video entitled the “Preston Plevretes Story.”
Athletes heard that stories like the one in the video are why they need to err on the side of caution when it comes to the symptoms of a concussion: they need to report headaches, cognitive impairment, and other signs and symptoms immediately so they can be assessed for concussion. According to the Mayo Clinic, concussion symptoms include:
- Headache or pressure in the head
- Temporary loss of consciousness
- Confusion or feeling as if in a fog
- Amnesia surrounding the traumatic event
- Dizziness or “seeing stars”
- Ringing in the ears
- Slurred speech
- Delayed response to questions
- Appearing dazed
Symptoms may be immediate or delayed in onset by hours or days after injury, especially long-term symptoms like memory complaints, trouble concentrating, irritability, sensitivity to light, sleep disturbances, depression, or disorders of taste or smell.
The school uses two tests: ImPACT and the King-Devick test, neither of which requires a licensed physician to administer.
ImPACT stands for Immediate Post-Concussion and Cognitive Testing, and along with the King-Devick test, it has been found to be a reliable indicator of traumatic brain injury during sports.
For the King-Devick test, athletes read the numbers from left to right, top to bottom, on the demonstration card as quickly as possible but without making any errors. Then they are asked to read each of the three test cards in the same manner.
The times for reading the numbers on all three cards are added up, and the total time is the summary score for the athlete on the test.
The number of errors made, provided they aren’t immediately corrected before going on to the next number, is also tallied.
Athletes’ scores are recorded before they take part in any contact sport to get a baseline reading and then retested after they report any concussion symptoms. The difference between an athlete’s times after a blow to the head that possibly caused a concussion and the baseline time for that athlete constitutes the real measurement that a concussion may have occurred.
The King-Devick test captures impairment of eye movements, attention, language, and other areas that correlate with reduced brain function.
Since repeated concussion is associated with neurological problems and metabolic abnormalities, detecting early signs of concussion can improve outcomes for athletes and keep them healthy. But if athletes fail to report symptoms that would trigger King-Devick or ImPACT testing, the risk of re-injury increases and, with it, the risk of long-term cognitive or other physiological impairment.
Before Illinois athletes can return to play after a concussion protocol has been initiated, they must be cleared by their doctor and the athletic director, athletes were reminded at the meeting.
The point, they were told, is to bring them back into the game gradually, to make sure they don’t have headaches, and so on. “Once you’re symptom-free, we release you to return to play, but we also ImPACT-test you again. So we’re going to err on the side of caution,” they heard.
Although return-to-play protocols are carefully developed with the long-term health of the student in mind, it would be more effective to develop new rules about tackling for sports like football and similar guidelines that protect students’ brains from injury in the first place in other sports. Our continued acceptance of brain injury in games boggles the mind.
Voxitatis reported in December that the issue of sports-related concussion is under review by the IHSA and other sports organizations, including the NCAA and NFL. Changes can’t come fast enough, since the sooner we change the guidelines of the game, the more lives we will save or spare from long-term disability, cognitive impairment, and suffering.