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New state law creates higher level of vigilance on concussions

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GINA R. HEINE
August 20, 2012

— A head-to-head collision in his sophomore football season left Parker senior Tyler Brooks seeing a flash of white.

"Everything was just dizzy," he said, describing his first concussion. "That wasn't my worst one."

Playing right field during a baseball game as a junior last spring, Brooks collided with the center fielder, whose elbow hit Brooks' temple.

"I was knocked out. I don't remember much until I got to the hospital," he said. "I guess I just kept repeating myself."

The concussion kept him home from school for a week, and he returned to half-days the second week until he could attend full-time in the third week. Close to a month later he returned to baseball, going on to gain honorable mention to the All-Big Eight Conference Team.

Brooks is back at practice for his last football season at Parker High School. He's healed and cleared to play sports after two concussions, but he's also received a warning from a neurologist: "Remember, you only get one brain."

"It made me think a little bit," Brooks said.

As the fall sports season begins, student athletes, coaches and parents face an increased awareness of the dangers of concussions after a new state law went into effect in April.

The law includes requirements for a youth to be immediately removed from a sport if he or she has a possible concussion, requires those involved in youth sports to be educated on the injury and prohibits a child from participating until a parent has signed a form saying he or she reviewed materials on the topic.

"We're trying to get as many people educated in the area as we can," said Dr. Darin Rutherford, a sports/family medicine physician at Mercy Sports Medicine and Rehabilitation Center, who has been conducting presentations to colleagues, sports and community groups.

What's changed?

While athletic trainers, physicians and coaches agree the new laws are a good move, many say it won't change their actions because they've already been focused on keeping kids safe.

"For me, it probably won't change anything," said Deanne Eccles Rotar, a sports medicine physician at Dean Clinic-Janesville East who works the football sidelines for Stoughton High School and the Rock County Rage.

Even before the law, if she knew someone was hit and had a head injury, Rotar wouldn't let him re-enter the game.

"I think it gives power to the officials and to the trainers and coaches to take a kid out," she said.

Coaches tend to put pressure on trainers to get a player back in the game, she said. She's interested to see if more kids end up in her office to get clearance to play.

"The biggest change for us is we may see a lot more kids coming in for post-concussion approvals," she said.

The nice thing about the law, Rutherford said, is it formalizes education for the public. It gets players, parents and coaches on board so they understand what a concussion is and how one is handled, he said.

The law applies to any activity for athletes ages 11 to 19 where there's potential for contact or collision, he said.

Craig High School Athletic Director and head football coach Ben McCormick said his school has always done a good job preparing kids on proper tackling and concussion awareness.

"In terms of what we're actually doing, it's not a big change," he said. "The big change is the documentation of it, and that being everyone must receive information in the form of basically a pamphlet."

Freshmen football players at Craig spent their first day of team activities earlier this month picking up equipment, including finding helmets that fit properly.

When part of a helmet fit correctly but remained loose elsewhere, a coach added a few pumps of air to the inside padding. Built with a layer of padding and a layer of air pockets, air could be let out or added to fit snug on a head.

All helmets are reconditioned every year, said Jeff Leider, Craig's varsity line coach. Helmets are gutted, gouges are filled and worn ones removed, he said.

Leider, who graduated in 1991, said helmet technology has changed a lot in the last decade, and he could recall only two helmet brands from when he played in high school. Now, with much more brand competition, helmet testing has improved, he said.

But concussion prevention is not just about helmets, said Leider, who also plays for the Rage.

"It's how we coach the kids to not hit with their heads," he said. "When I was in high school, you would have seen the front of my helmet just gashed up. Now, you get a penalty (if) you lead with your head."

On the field

Concussions can be more common in girls, and the younger athletes are the more vulnerable they are, Rutherford said. People with previous concussions also are more susceptible, he said.

The more contact and collision involved in a sport, the greater the risk. While football, hockey and wrestling are often first to come to mind, physicians say soccer too often is overlooked.

A common misconception is that consciousness must be lost for a concussion to have taken place, doctors say. In actuality, it only occurs in 10 percent of concussions.

During fall sports, doctors can see upwards of three to five concussions a day, Rutherford said.

Basic life support signs are checked on the field when a player suffers a head injury, said Rutherford, who has been team doctor for Janesville Parker and Craig football for 13 years, as well as high school hockey teams, the Janesville Jets, Beloit Snappers and Beloit College.

Then a secondary neurological assessment is done, making sure the player can move his arms or legs. The cervical spine is stabilized, and the player is moved to the sidelines where he is asked questions such as his name, where he is, what play he was hurt on, etc. Next is a memory test, he said.

Once a player has concussion symptoms, he is not allowed back in the game. While that's part of the law, it's been a recommendation for years, Rutherford said. A player's symptoms can evolve over the first 20 to 30 minutes to the next 24 to 48 hours, and Rutherford said he's seen people deteriorate right before his eyes.

Players then see their primary care physicians for follow-ups, and a player goes through a five-step process before receiving approval to return to practice.

One tool physicians often have is a baseline test a player takes before the season. After receiving their equipment at Craig, freshman football players take the Immediate Post-Concussion Assessment and Cognitive Testing or Impact Test on library computers. The test measures aspects of a player's cognitive functioning, including memory and reaction time.

The baseline is then used to compare and evaluate an athlete's recovery following a concussion.

"It's just one tool that a physician has available to him to help the decision of when to return to activity. So it's not a standalone thing," said Kathy Calkins, an athletic trainer with Mercy Sports Medicine who administered Craig's Impact testing.

Sometimes kids say they feel great, but the tests show their reaction times are slow, she said.

The testing is not a state requirement, but many area schools complete it.

Increased attention

The increased attention on the long-term effects of concussions, particularly through professional sports groups such as the NFL, has helped increase awareness locally.

With more attention on potential long-term consequences, there should be less emphasis on coaching staffs to make a player participate even though he or she may be injured, said Dr. Thomas Berentsen, a neurologist at Dean who has been practicing in Janesville for 30 years.

"I think that's great," he said. "I think that in all sports, but particularly high school sports, the potential for lifelong damage that occurs after repeated concussions is something that we haven't paid attention to."

People are optimistic, which sometimes leads to wild, inappropriate expectations that young athletes will play professionally someday, he said. While the odds of that are quite small, the risk of having permanent damage from repeated injuries is significant, he said.

In his career, Berentsen saw a lot of hesitation from parents and kids when he had to tell them a kid couldn't go back to playing.

"I notice now, I get much less pushback," he said.

Calkins estimates the number of concussions probably isn't increasing; people are just reporting them more, she said.

Parents also seem more appreciative when their child is pulled out of a game, Rotar said. While the NFL is one motivator, people are learning more that brain development is still occurring through the teenage years, she said.

Brooks thinks more about his future after hearing the difficulties retired NFL players face.

"It's not like you can just beat (your body and brain) up and get a new one later in life," he said. "You've got to be careful with what you got."

At the same time, he said there's not much you can do on the field to prevent a concussion when you're playing hard. Brooks worries a little about suffering a third concussion.

"But I can't really sit around and think about it, hoping I don't get another," he said.

FACTS ABOUT CONCUSSION

Wisconsin concussion law

A new law supported by the NFL and Green Bay Packers pushing concussion awareness was signed into law in April. Thirty-six other states have a similar concussion law.

The law:

-- Requires immediate removal of an individual from a youth athletic activity if symptoms indicate a possible concussion. If a concussion is confirmed, individuals can only return to competition or practice after being evaluated by a trained health care provider, who must provide written clearance.

-- Requires all youth athletic organizations, including club sports, to educate coaches, student-athletes and parents on the risks of concussions and prohibits participation until a parent or guardian has returned a signed information sheet saying they have reviewed the materials.

-- Includes provisions to protect coaches, officials or volunteers from liability if they fail to remove an athlete from competition, unless there is gross negligence or gross misconduct.

What is a concussion?

A concussion is a type of traumatic brain injury that interferes with normal functioning of the brain. A concussion can be caused by a bump, blow or jolt to the head or body. Any force to the head causing the brain to literally bounce around or twist within the skull can result in a concussion.

More than 90 percent of concussions do not involve loss of consciousness.

Signs/Symptoms

Here are some signs others can see in an injured athlete:

-- Dazed or stunned appearance

-- Change in the level of consciousness or awareness

-- Confused about assignment

-- Forgets plays

-- Unsure of score, game, opponent

-- Clumsy

-- Answers more slowly than usual

-- Shows behavior changes

-- Loss of consciousness

-- Asks repetitive questions or memory concerns

Here are some of the more common symptoms an injured athlete feels:

-- Headache

-- Nausea

-- Dizzy or unsteady

-- Sensitive to light or noise

-- Feeling mentally foggy

-- Problems with concentration and memory

-- Confused

-- Slow

Sources: Wisconsin Department of Public Instruction, WIAA



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