A blow to the head was once referred to as "seeing stars" or "having your bell rung," but these days coaches, athletes and parents are taking concussions seriously.
An important step on the road to recovery for athletes who have sustained an injury involves knowing what was normal. A team of South Dakota State University researchers led by associate professor Bernadette Olson is providing these valuable pre-injury baseline measurements for rural youth in southeastern South Dakota.
Beginning in 2011, Olson and her team developed a sports concussion protocol that includes a neuro-cognitive assessment tool called ImPACT, balance testing and quality-of-life measures. All are designed to help health care practitioners evaluate injuries and develop a care plan appropriate for each athlete.
"We have more than 1,000 students who are current in the database," she said proudly. Her team of one graduate student and approximately 15 undergraduates does yearly testing for nine area schools--Arlington, Brookings, Castlewood, Deubrook, Elkton, Estelline, Lake Preston, Oldham-Ramona and Sioux Valley.
Helping rural schools comply with law
In 2011, South Dakota passed legislation requiring that any player who sustains a head injury be removed from the game immediately and not be allowed to return until a health care professional declares him to be symptom-free. The law applies to all schools who participate in South Dakota High School Athletic Association sports.
Compliance with the law is especially difficult for small school districts, most of which do not have an athletic trainer, Olson explained. The project is supported through a collaborative research grant from Avera Health and the SDSU College of Education and Human Sciences.
Making a difference for injured athletes
Brookings High School athletic trainer Angela Brown can see the impact of Olson's work. All Brookings High School student-athletes have yearly baseline testing. This year hockey and soccer players were added.
Over the last two and a half years, 60 of the approximately 650 student-athletes have sustained concussions -- some more than once, according to Brown. Those who have sustained one concussion are at higher risk for subsequent concussions. Because of this baseline testing, Brown is able to show parents and student-athletes where the player was and where he is now.
"It's objective data that shows the effect the concussion has had on cognitive functions, memory and reaction time -- factors that are otherwise hard to evaluate," she said. Comparing these post-injury results to the baseline scores gives a student-athlete and his family evidence of the changes resulting from the concussion.
The ImPACT report must then go to a medical professional who is trained to interpret the results. "Without that training, ImPACT is not as useful and could be misleading," explained Dr. Verle Valentine, a certified impact consultant at Sanford Health who sees patients in Brookings twice a week. He helped formulate the S.D. concussion law and is actively involved in concussion research.
By using clinical evaluation and the information from ImPACT testing, a trained provider can then recommend what accommodations in terms physical and academic activity need to be made to allow him to recover, according to Brown.
That can involve pulling the student-athlete out of school or providing a longer testing time or less reading and homework. Typically the student-athlete is out of the game for at least 10 days, she added.
Sometimes players are reluctant to tell the athletic trainer that they've suffered an injury, she admitted. But she tells them: "I'm looking out their whole well-being. From the neck on down, it can be taped, braced and splinted, but from neck up, it's a totally different deal."
As word gets out about this program, Brown said, "It's gaining a lot of support in the community." People recognize the value of the testing, she added. "Parents thank me."
Coming back without a baseline test
Kristi League of Brookings knows how difficult it is to assess when a child's brain has returned to normal without baseline testing. Her daughter Charlotte, a figure skater, sustained a concussion at the ice rink on Oct. 8. It took 20 days until she was cleared for normal activity. Brookings figure skaters have not participated in the program.
"We were making assumptions on healing rather than having somewhere to go from," League explained. She favors baseline testing for all school children, saying even a fall from playground equipment could result in a head injury. The ImPACT test can be used for children 11 and older, according to Valentine.
"You get one brain," League said. "Sports can wait until your brain is well enough."
The skating club is developing a concussion policy and putting in place a compliance officer -- all prerequisites to having Olson's team conduct pre-injury testing.
Learning from experience
All Lake Preston students in grades 7 through 12 have had baseline testing, regardless of whether they participate in school sports, according to superintendent Tim Casper. Students can be injured in a physical education class or an auto or bus accident, he pointed out.
The district did ImPACT testing for two years through a free program at Dick's Sporting Goods before it became involved in Olson's program.
Casper's motivation came from his son, who sustained three concussions playing football in high school and college. ImPACT testing helped Casper decide to pull his son out of college football. "He had tough days with headaches and difficulty just getting through college," he explained.
"We have to educate people," Casper said. "This game is not as important as your son's or daughter's well-being. Sometimes you have to make tough decisions."
Samuel Schimelpfenig, a pediatrician at Avera's McGreevy Clinic who has worked with Olson's project, said, "This is highly valuable work because it focuses on an area where we still need more information -- how to best manage these young athletes with concussions." Schimelpfenig, who is board-certified in sports medicine, is seeing more patients with concussions, in part due to increased awareness about the symptoms and the need to be evaluated by a medical professional.
"It's important for athletes in rural communities to have the same level of expertise as high-level concussion clinics," said Valentine. However, it's a challenge for rural health care professionals to keep up to date when they see only a few cases a year. That's why the support of specialists, like Schimelpfenig and Valentine, is important, according to Olson.
Brown foresees a pre-injury, baseline testing protocol one day becoming a part of the sign-up process for all activities. "With Bernadette and SDSU, we could really be a role model community."
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