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Working the Sidelines Working the Sidelines

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From my perspective as a person who is a first responder, who is likely to be the first person to evaluate a patient with a mild traumatic brain injury, I also deal with issues of education and awareness in my population, not only with my students but with their families and sometimes with different medical professionals that we will deal with. When we get a student that has suffered a mild traumatic brain injury or anything that we suspect to be of that type, we have a very low threshold for referring these people out to people who are more qualified and more equipped to make a specific diagnosis and start a really integrated, thorough treatment plan. This has not always been the case. I've been at St. Albans School for 18 years, and I can tell you at the beginning of the process, you were kind of on your own. There wasn't a lot of research, there wasn't a lot of material to refer to in managing mild traumatic brain injury. I too see firsthand the challenges that are presented in integrating a treatment plan with a very challenging academic atmosphere, with a very challenging social atmosphere, with a very challenging peer pressure to return to play, to kind of work your way through this injury that doesn't really appear in any way that anybody can see. If you have a sprained ankle and you're limping around, you have a swollen ankle, people can see you have a swollen ankle, people can see you're not ready to go. Particularly with teenagers and adolescents, they don't really understand that if they don't see something wrong. So there's a lot of peer pressure going around for kids who have had a mild traumatic brain injury to kind of underreport their symptoms. One study that we did years ago in regard to a device used on a football helmet, we did surveys regarding the people who were using the device as opposed to the people who were not. And what we really found at the end when we brought all the surveys in is that there was a huge underreporting by the students of incidence of mild traumatic brain injury. So that is one of the really tough issues that we deal with is educating everybody. And I think one of the things that I try to educate my parents and my kids on is defining a term, defining a term because I'll have a parent come in and say, "Well, he wasn't out cold. He didn't have a concussion." They've got a thousands sets of different criteria that they use pretty randomly that they've heard here, there and everywhere to define what they think is a concussion. And the other challenge that we have is sometimes in the medical community we will get somebody who has been evaluated but hasn't been thoroughly or, in my opinion, sometimes properly evaluated, and we will get a return to play criteria that's inappropriate. So there's a lot of difficulty in awareness and defining of terms.

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"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.

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