Area College Athletic Trainer On Concussions in Athletics

By Alison Aubert, Head Athletic Trainer Solano Community College:

As a Certified Athletic Trainer at the college level for the past 27 years, concussions in athletics is an important area of focusfor health care professionals. Athletic trainers have always taken concussions very seriously, and have faced severe pressure by athletes, parents and coaches to allow those injured to return as soon as possible.

Thankfully, the medical community has united and set up safe guidelines for prevention, treatment, and return to play guidelines for concussed athletes.Concussions happen in all sports and can come from a blow to the head, whip action, and falls.

In the past decade 40% of high school athletes return to competition too soon after a concussion (Center for Injury Research and Policy),and 16% of high school athletes return to competition the same day after a concussion with loss of consciousness (Centers for Disease Control and Prevention). These cases commonly occurred when a certified athletic trainer was not on staff to monitor these athletes.

Even a relatively minor second concussion can have devastating consequences. A second concussion is five times more likely to occur in the same season after an initial concussion, and most major traumatic brain injuries in youth are related to second impact syndrome.

Four weeks post-concussion the brain is hyperglycemic, vasoconstricted and demonstrates increased electrical activity.Therefore, identification of all concussions is critical to prevent severe trauma and sudden death.

On October 2011, the state of California signed into law California AB 25, which requires the removal of an athlete from competition if a concussion is suspected until a licensed healthcare provider sees and clears the athlete. Prior to their return, the athlete must sign a document, so that he or she understands the seriousness of the head injury. If experiencing any symptoms, an athlete must report this immediately to the coach, athletic trainer or sideline personnel.The most important thing is to try to remove the stigma of leaving a game due to injury.

Many athletes believe that leaving a game due to injury is “letting their team down,so they will hide their symptoms which makes it hard to diagnose and treat concussed players.Sideline concussion assessment is dependent on the athlete’s honesty and lack of coverup.

Coaches, athletic trainers and physicians watch for concussion signs and symptoms on the side line of practice and competitions. Knowing the athlete, and their normal behavior,is a great way to catch it early. Red flags include changes in body language, sideline behavior, eye contact, and the ability to communicate. If athletes display any of the above, sideline athletic trainers will assess the athlete and determine if they have suffered a concussion.

Symptoms of concussion include: confusion, anterograde amnesia, retrograde amnesia, loss of consciousness, disorientation, feeling “in a fog”, vacant stare, inability to focus, delayed verbal & motor responses, slurred/incoherent speech, excessive drowsiness,headache, dizziness, balance disruption, nausea/vomiting, irritability, fatigue, anxiety, sadness, trouble falling asleep, sleeping more than usual, and sleeping less than usual.

Home Care Guidelines Following a Concussion

1. Ice on the back of the neck will limit blood flow to the head, and helps with pain

2. Allow the Athlete to Rest as much as possible

3. Avoid taking medications that may cover up symptoms

4. Document symptoms, severity and duration

5. Avoid loud noise and bright lights

6. Homework, reading and school work may need to be postponed

7. Athletes whose symptoms worsen should seek medical assistance

Neurocognitive testing is available, validated and proven reliable to perform pre testing(ImPact, SCAT ) which can be used as a base line measurement. A baseline measurement is used to measure as a point of reference once an athlete has sustained a head injury. Once an injury has occurred, the athlete, once symptom free, retakes the baseline test. The data from the original test is compared with the newest test.A baseline measurement allows the athlete to be tested on a daily basis, once they are diagnosed with a concussion. This daily data is used to decide when it is safe for the athlete to slowly return to activity. However consistent testing by a certified athletic trainer (or a health care provider) is necessary for proper interpretation of the results.

There arethree steps for return to play to consider:

1. Absence of symptoms at rest

2. Normal physical examination (neurological)

3. Return to baseline, or normative neurocognitive test score (we do not retest until symptom free)

Functional progression is a common sense approach to returning athletes to activity with a symptom free approach. This approach mandates that you wait for the athlete to be completely symptom free(including minor headaches), until you can begin each step.

· No symptoms at rest, 24 hours

· No symptoms with gentle aerobics, 24 hours

· No symptoms with interval work, 24 hours

· No symptoms with on the field, on the court practice

· Cleared for full competition

In my experience this can vary from 5 days to 2 weeks depending on the concussion history of the athlete. Athletes with a history of concussions tend to have symptoms with minor activities; due to the hypersensitivity of the brain, and tend to last longer than first time concussion patients. This is why physicians and athletic trainers are limiting the number of concussions allowed to become physically cleared for play.

Athletes with multiple concussions in their history are referred to neurologists for advanced testing and counseling.

The NCAA, NFL, CIF and CCCAA (Community college athletic association) are presently looking at changing the way athletes train to prevent concussions. Concussions are most common in soccer, football, rugby, basketball and lacrosse.

However concussions can and do happen in all sports. These organizations are looking at limiting the number of times the head is stressed in practices (example;limiting contact in football practice, heading the ball in soccer). Acceleration technology is also being utilized to measure the force of blows to the head. This data is still being adjusted and in the future may be a tool that can be used to prevent some concussions. However, limiting the amount of time that a team practices “full speed” (high intensity), per week is in the future of athletics at all levels, including the NFL.

Unfortunately I find that Solano County seems to be slow in adopting the use of certified athletic trainers at the high school and youth level. These are mandated in all levels of college and Professional athletics. The high schools in many states utilize certified athletic trainers to prevent and treat all injuries in athletics. However,they are not common in our region. Parents should encourage their schools to hire a certified athletic trainer to protect the health of their athletes.

Alison Aubert, MS, ATC, is president of the CCCATA and Head Athletic Trainer Solano Community College.

Photo credit: L.A. Cicero/Stanford News Service.