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Concussion awareness yields cautionary responses

Dec. 16, 2010

By Mal Boright
Observer correspondent
Champlain Valley Union High soccer player Emma Eddy dribbles the ball during a game in September 2009. Eddy suffered a concussion early in the soccer season this fall. (File photo)

The growing awareness of the dangers of concussions in youth sports has brought a quick response from individual schools including Champlain Valley Union High, as well as the Vermont Principals Association.

Within the past two years, partly as a result of long-term effects of numerous head injuries to National Football League players, new information has brought new attitudes and responses when high school athletes are thought to have suffered concussions in games, practices or even off the playing fields.

The old days, when a player with a head injury was thought to have had his “bell rung” and returned to the game as soon as he could count to three — or failing that, two — are long gone.

“Now, a player has to be symptom-free for 24 hours before slowly returning to practice and remain symptom-free for seven days before being eligible to play in games,” CVU athletic director Kevin Riell said in a recent interview.

Riell also pointed out that symptoms are “not always immediate,” meaning additional caution is required before a return to athletic activity.

Certified trainer Tony Lora attends all Redhawks home contests and makes judgments related to medical issues.

Medical studies as described in The New York Times and other publications have revealed that frequent concussions can lead to serious brain impairment and even dementia.

Athlete experiences

CVU soccer player Emma Eddy found herself with a concussion after colliding with an opposing player in an early season game at the Redhawks’ home field.

“We had the collision and I fell to the ground and hit my head front and back,” Eddy recalled. “I went black for a few seconds. I got up but I felt a little shaken up and knew I needed to come off.

“I told Tony (Lora) that I should feel better and be able to go back in, but he said no, absolutely not.”

In Eddy’s case, symptoms did not fully emerge until the following day.

“I woke up the next day and lights seemed really bright and it was really hard to focus,” she said. “That is when I knew I had a concussion.”

She said it took about two weeks for the symptoms to finally go away and then another week for a slow return to full soccer play.

Another cautionary story is that of CVU senior Amanda Kinneston. During a 2009 late season soccer game, she was hit in the jaw by a soccer ball but did not realize for some time that she had suffered a concussion.

After the season was over she said she “was not my usual, cheerful self and I was having headaches.”

A visit to a physician and consultation with Lora followed. It was determined that Kinneston had concussion symptoms.

“There was no running or athletic activity,” she said.

It was not until seven days after the last headache that she could slowly resume training for basketball. She missed the first two weeks of the schedule.

Kinneston has fully recovered and had an All-State soccer season and is a starter on the basketball squad, but she says she is still being monitored by her parents and coaches.

Eddy acknowledged that for a competitive athlete, the sitting out goes against the grain, but is important.

“My advice for anyone hit in the head is to immediately come out of the game and sit,” she concluded.

Growing awareness

The Vermont Principals Association, or VPA, has ruled that all coaches of high school winter sports had to complete a National High School Federation online course on concussions by the end of November. The course takes about 20 minutes to complete.

CVU has a course at its website, www.cvuhs.org, which can be accessed by clicking on athletic links after getting into student activities.

VPA Associate Executive Director Bob Johnson says research on concussions is changing almost on a monthly basis.

“This is very serious,” Johnson emphasized.

Nationally, there are at least two bills before Congress where House committees have held hearings.

In Vermont, a bill failed to make it out of the Legislature last spring but new legislation is expected to get attention in the session that begins in January.

Johnson said the VPA has a Sports Medicine Advisory Committee that is dealing with concussion issues and has recently issued a list of licensed health care professionals who can clear athletes thought to have suffered concussions to return to competition.

The list includes medical doctors, physician assistants, nurse practitioners and certified athletic trainers such as Lora.

“I am comfortable with the list the committee has come up with,” Johnson said.

Committee member Dr. James Slauterbeck of the University of Vermont College of Medicine noted during a recent telephone interview that the familiar system of grading concussions as mild, moderate and severe is now a thing of the past, partly because symptoms are not always present immediately after the injury.

“Symptoms such as headache or memory loss may not appear until the following day,” Slauterbeck said, noting the difficulty of immediately detecting symptoms. Plus, the culture of high school kids is to want to keep playing.

He is adamant that when athletes exhibit symptoms they must be held out of games and practices under guidelines that provide for a slow return to full participation in the particular sports only after all symptoms are gone.

As for advice for athletes and parents, Slauterbeck had a few points of emphasis.

“Repetitive concussions can lead to major problems later in life,” he warned.

He reiterated the necessity of a slow return of “build up” back into the sport and even holding the athlete out of school for a day or two to allow for “cognitive rest.”

A recent New York Times article noted that concussions are a growing concern for just about all youth sports.

Quoting figures from the medical journal Pediatrics, the Times noted that individual reported concussion rates among 12- to 17-year-olds are highest in ice hockey. The reported number was 29 cases per 10,000 participants. It was also pointed out that these reports were primarily for emergency room treatment and not necessarily for visits to physicians’ offices or other treatment centers.

Football was next, with 27 per 10,000, followed by soccer, basketball and baseball with 8, 4, and 3 cases per 10,000.

Lora has seen concussions in most sports over the years and developed a cautionary rule for immediate response once a concussion is thought possible.

“When in doubt, sit them out,” he said Monday.

CONCUSSION SYMPTOMS

Fletcher Allen Health Care describes a concussion as a brain injury caused by a bump, blow or jolt to the head that disrupts the way the brain normally works. Even a “ding” or bump on the head can be serious.

Symptoms reported by athletes include the following:

• Headache

• Nausea

• Balance problems or dizziness

• Sensitivity to light or noise

• Feeling sluggish

• Feeling foggy or groggy

• Concentration or memory problems

• Confusion