New state regulations about recognition and treatment of concussion injuries to high school students are protocols that have been used at the Martha’s Vineyard Regional High School (MVRHS) for the past four years.
In fact, new athletic director Mark McCarthy and school trainer Tania Laslovich are as close to expert as it gets in the new and mushrooming research on the treatment and the effects of impact on brain functionality from blows received on the playing field, or just bumping your head getting in the car.
“We treat about 30 concussions a year, on average, among our student population,” Ms. Laslovich said this week. “About 90 percent of them occur in athletes across virtually every sport,” she said. With a total population of about 700 students, that’s less than a 3 percent chance. But athletes run a higher risk, about 9 per cent, with 25 concussions a year among 300 school athletes.
“Those are cases reported or identified by us. But what we’ve learned is that, nationally, athletes, particularly male athletes, are reluctant to report symptoms,” she said. Symptoms can include dizziness, headache, nausea, slurred speech, double or blurry vision, sensitivity to light or noise, sluggish response, confusion, and memory problems, she said.
As a result Ms. Laslovich and coaches prowl the sidelines constantly, monitoring the action for heavy blows and contact and watching athlete behavior after contact. “I watch for signs like unsteady gait or head-shaking. I’ll do an evaluation and we pull the kid out if there are concussion-like symptoms,” she said.
When a concussion is identified, a specific process takes place designed to monitor and resolve neuro-cognitive disruption, the medical term that describes the effect of concussion on the brain. “Concussion is not a brain bruise, it’s a disruption of the brain’s normal patterns,” Ms. Laslovich explained.
A key element, she said, is a cognitive test called ImPACT, which measures the levels of a range of cognitive skills compared to a baseline level that each athlete is encouraged to establish before participating in sports.
The ImPACT test cannot be mandated, “But we strongly — make that very strongly — suggest to all athletes that they establish an ImPACT baseline,” Mr. McCarthy said. Before returning to the Island last year as the high school athletic director, Mr. McCarthy, a certified athletic trainer, as is Ms. Laslovich, was immersed in concussion treatment protocol for more than a decade in the state of Connecticut.
“I was the concussion program director at Childrens’ Medical Center in Hartford and helped write the state legislation for concussion management while I was there,” he said “I’ve seen more than 1,000 concussion cases. The higher incidence is in football and soccer but cross-country runners, rowers who catch an oar, are at risk. There really aren’t many sports that are immune to concussion,” he said.
Coaches are often the first observers of concussion and the high school’s coaches have been trained to spot an event. At that point the trainer, school nurse, parents, and physicians join recovery treatment.
Concussion has been known about for centuries. The ancient Greeks and Romans referred to the condition and while Mr. McCarthy and Ms. Laslovich know how best to treat concussion, research and tracking of the injury is relatively young.
“Are there more concussions today? That’s a good question for which you can’t get a true answer. The research on concussion done beginning in 2000 has doubled the research on the subject more than has ever existed,” Mr. McCarthy said. “As late as 1997, the rules for high school sports said a player could return to the field in 15 minutes if the symptoms resolved,” he said.
“More kids are playing and they are playing year-round so there’s more exposure to injury. A kid who used to step on the field 30 times a year now steps on the field 150 times,” he said.
High-profile athletes who suffered career-ending injuries, and older athletes reporting health issues believed to be concussion-related, are driving the renewed focus on concussion.
Certainly it’s driving Ms. Laslovich. “The best course of treatment is to get rid of the symptoms, to allow recovery to occur. That’s critical. We don’t understand all the long-term effects of concussion yet but we know that a successive concussion before recovery is complete can lead to big problems, even death, down the road and later in life,” she said.
Mr. McCarthy concurred. “We don’t know why some people are concussion-prone and others are not, for example. What we do know is that no two concussions are exactly alike,” he said.
Ms. Laslovich knows what works, and she is a ferocious proponent of correct protocol. “Every case is different. Some kids recover in a few days and test normally.
“Every kid gets ImPACT-tested, some four or five times, whatever it takes to assure normal levels, but we also get a physical evaluation to insure that motor skills and the brain are working together. Have you ever seen someone mis-button a shirt when they knew what they were trying do but the wrong motor signals were being sent? That’s the kind of thing we’re looking for,” she said.
While recovery from concussion can take months in rare cases, “Most kids recover within a few days to a week, sometimes two or three weeks,” she said. Virtually every concussion sufferer misses a few days of school and that’s purposeful, Ms. Laslovich said.
“The brain function has been stressed and any kind of mental stimulation hinders recovery. If you had a sprained ankle, would you run on it? Of course not. When kids are at school they are using their brains and the brain needs rest and recovery. That means quiet time at home. No TV, no music, or reading. Rest. For as long as it takes,” she said.
Ms. Laslovich recommends the websites of the Center for Disease Control and Sports Concussion of New England as primers for learning about concussion and treatment. Both are linked to the Athletics page on the MVRHS website, mvrhs.org.
The most important thing for people to understand is that not every hit is a concussion, but a “ding” or “seeing stars” with symptoms like headache, nausea, and dizziness are consistent with concussion.
“If you get hit and have any symptoms, get checked out,” Ms. Laslovich said. “If you get hit again before you’re healed that can lead to catastrophic results, particularly in the high school group whose brains are still growing.”