Ahead of the Game

Rosemarie Scolaro Moser, PhD, Dartmouth College Press

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Multimedia

• "If you think you have a concussion, don't hide it, report it ... I didn't know it could get this bad." Tracy's Story: The End of an Athlete's Career
• From acclaimed director Steve James (Academy Award-nominated "Hoop Dreams," "The Interrupters"), HEAD GAMES is a revealing documentary about the silent concussion crisis in American sports. Athletes from the professional to the youth levels share their personal struggles in dealing with the devastating and long-term effects of concussions, an epidemic fueled by the 'leave everything on the field' culture so prominent in American sport. Inspired by events from the book 'Head Games' written by former Ivy League Football Player and WWE Wrestler Christopher Nowinski, the film contrasts eye-opening evidence and cutting-edge science on head trauma from the nation’s leading medical experts with first-hand accounts from the athletes, coaches, and parents who must tread the difficult balance between sports excellence and basic self-preservation. Head Games, the Film
• Neurologist Dr. James Kelly, one of America’s top experts on treating concussions, talks about the data on heading the ball in soccer and brain injury. This is an excerpt from BrainLine's webcast Concussion: Understanding Mild Traumatic Brain Injury. See full webcast here. Does Heading a Soccer Ball Cause TBI?
• Free for teachers, parents, coaches, and kids, learn about the CDC's Heads Up! toolkits. The CDC's Heads Up! Toolkits
• More and more research is proving that repetitive shaking of the brain or hits to the head whether from combat or contact sports can often result in long-term neurological decline.

  See all videos with Dr. Richard Ellenbogen.

  What We Know and Don't Know About Repetitive Hits to the Head
• "Don't even try to fool me because I'm watching you!" So says Jay Driscoll, ATC / CSCS, athletic director at Washington, DC’s St. Albans School, to his student athletes, alluding to the fact that some athletes cover up a mild brain injury so as to stay in the game. With a no-nonsense attitude and a keen sense of humor, Jay talks to BrainLine about his program on injury prevention, care, and rehabilitation services as well as how he helps his athletes meet and exceed demands by enhancing their physical fitness, performance, and health.
  
  Transcript of this video. Working the Sidelines
• Concussions can be subtle and often invisible. That's why coaches, parents, and teammates need to have a high index of suspicion.

  See more videos with Dr. Julian Bailes.

  High Index of Concussion Suspicion Needed on the Sidelines
• Emory University scientist Michelle LaPlaca, PhD, talks about her work on DETECT, a low-cost, portable device to detect possible neurocognitive symptoms after a hit to the head. A Portable Device to Detect TBI on the Sidelines
• Not every school or team has a medical expert or athletic trainer on the sidelines to test players after a suspected concussion. But there are simple guidelines and resources to help.

  See all videos with Dr. Richard Ellenbogen.

  Keeping Youth Athletes Safe Whether on Rural or Urban Team Sidelines
• Research shows that brain injury in children is far worse than in adults — with longer recovery time and greater future risk. New rules and awareness are helping but there's more work to be done.

  See all videos with Christopher Nowinski.

  Christopher Nowinski on the Nuances of Brain Injury in Children
• Tell young athletes to keep an eye on their teammates. If a player seems impaired from a head to the head, they need to speak up to get that teammate safely off the field.

  See all videos with Christopher Nowinski.

  30 Second Message to Help Prevent Sports-Related Brain Injury

The Parent’s Guide to Youth Sports Concussions

Chapter 4: Indentifying and Treating Youth Concussion: An Eight-Step Plan to Get Back in the Game

Here’s the good news: a growing number of colleges and high schools across the country have finally started taking concussion prevention and management seriously. By educating athletes on the signs and symptoms of concussion, requiring baseline and post-concussion neurocognitive testing, and — most important — removing youth athletes from play immediately following a brain injury (even a suspected on), we’re making great strides in protecting the safety of our children, and ensuring that they will have long, happy, and healthy athletic careers. There’s even a nationwide legislative movement afoot to require all schools and athletic programs to establish formal concussion-management programs.

Now, here’s the bad news: the majority of American middle schools and elementary schools, as well as most community and recreation-based sports leagues, do not have any kind of program in place to identify, prevent, or manage concussions. As most parents know, rarely will you find an athletic trainer or other health care professional at a soccer practice for 6 year olds, or on the sidelines at a peewee football game. Rarely have youth sports coaches been educated about the dangers of a brain injury, or even shown what to look for. That means that millions and millions of young children are not only at greater risk of sustaining a  concussion, but are less likely to receive the proper care and medical attention when they do get injured. Parents and coaches are often forced to navigate the confusing world of concussion aftercare alone, without any sort of guidance about where to go, what to do, who to consult, or how to help their child on the road to recovery.

This chapter outlines a detailed eight-step plan to help athletes, parents, and coaches determine exactly what to do if they suspect that a child has sustained a concussion. I’ll also discuss alternative (less mainstream) therapies that have shown some anecdotal effectiveness in treating lingering symptoms and post-concussion syndrome. And I’ll explain the frequent need for academic accommodations at school, and suggest ways to ensure that your injured athlete is getting the help he or she needs.

Step 1: Preseason Baseline Testing

If your child’s school or sport team already has a formalized concussion-management program in place (one that incorporates neurocognitive baseline testing), then step one is easy — your child will be tested automatically in the preseason, before she ever sets foot on the field. It’s still a good idea to check that your child is eligible to participate in the testing program. Some schools, for example, due to limited financial resources, may choose to test only varsity athletes, or may opt to establish a baseline only once (typically during freshman year) without every updating the scores. Don’t just assume that your young athlete has undergone baseline testing, or that her baseline test is valid or up to date.

If there is no formalized concussion program in place, you can obtain private baseline testing from a sports concussion specialist. These are licensed health care professionals who have been trained in administering and interpreting preseason and post-concussion neurocognitive testing. Such individuals include neuropsychologist, as well as some physicians who specialize in sports concussion. A neurocognitive specialist can then store baseline data should it be needed for a post-concussion comparison in the future. To find a listing of neuropsychologists in your area, you can log on to the National Academy of Neuropsychology’s website (nanonline.org). Or, to find a listing of CICS and test sites, log on to the IMPACT website (impacttest.com). Be aware that health insurance companies typically will not cover baseline testing because it is considered a “well visit,” meaning there is no diagnosis or disease for which the child is receiving medical services. Be wary of organizations that allow you to take a baseline test in your home, without oversight or education from a concussion specialist.

Regardless of whether baseline testing is obtained in school or in a private clinic, be sure that your child, coaches, athletic trainers, and other school personnel have received some kind of training in concussion prevention and identification. The best way to identify a concussion is to know what to look for.

Step 2: Awareness and Vigilance

One of the most common questions I hear form both parents and coaches is, “How do I know if the athlete actually has a concussion?” Vigilance is key. Detecting a possible brain injury is relatively easy when there are obvious signs: if the child blacks out or can’t keep his balance, for example. (And in such cases, you should seek immediate medical attention.) Otherwise, parents and coaches should be familiar with the behaviors of the youth athletes in their charge, and should become active observers at practices and games. Watch out of blindside hits and rough tackles, and keep a particular eye on athletes who have experienced a concussion in the past.