Facing Concussion Management Head-On
When Grant Page took a hard hit playing in a high school football game last October, he did what many young athletes would do. He tried to continue playing.
A brief examination by his athletic trainer and it was obvious that George Ranch High School’s #23 needed immediate medical attention. The trainer looked at his parents in the stands. They bolted to the sidelines.
“We took him to Memorial Hermann Sugar Land Hospital in the car,” said Grant’s mother, Debbie Page. “We didn’t even wait for the ambulance.”
It turns out Grant had suffered a concussion. Each year, U.S. emergency departments treat an estimated 135,000 sports- and recreation-related traumatic brain injuries, including concussions, among children ages 5 to 18. Concussions are a temporary change in brain function, resulting from a sudden shift of the brain after a blow to the head. Continuing to play after a concussion can worsen symptoms and makes athletes vulnerable to further injury and even death.
In an effort to reduce multiple concussions and the potential for long-term brain damage among student athletes, Texas House Bill 2038 was signed into law in June. It requires public high schools to remove an athlete from play after he or she sustains a significant head injury. A physician evaluation is required along with written authorization to return to play.
William Mosi Jones, M.D., team physician for George Ranch High School, is affiliated with the Memorial Hermann IRONMAN Sports Medicine Institute. He is board certified in physical medicine and rehabilitation and primary care sports medicine.
When Dr. Jones examined Grant, he found the classic signs of concussion: headache, dizziness and imbalance, trouble concentrating and extreme sensitivity to light and sound. Grant also didn’t remember the game.
One of the tests Dr. Jones ordered for Grant was ImPACT (Immediate Post-Concussion Assessment and Cognitive Testing). This computerized assessment tool measures subtle changes in brain function, evaluates post-injury condition and tracks recovery. It is widely used by college and professional athletes.
“A concussion affects brain processing,” said Dr. Jones. “You won’t see bleeding or brain swelling, though we run CT scans and MRIs to rule out something more serious. ImPACT looks at verbal and visual aspects of memory, processing speed and accuracy.”
Dr. Jones notes that sometimes post-concussion memory problems and concentration issues are not immediately apparent.
If an athlete has had a baseline ImPACT in the past two years, retesting following a concussion can show the extent of the brain injury. If a baseline test is not available, as was the case for Grant, age-gender comparisons are used. The honor student performed so poorly on his initial test that everyone thought the computer malfunctioned. In fact, Grant’s damage was so severe that his processing speed was well below normal for his age.
Dr. Jones immediately ordered cognitive rest to accompany Grant’s physical rest – no texting, loud movies or video games. Exposure to these brain- stimulating activities can make symptoms worse.
Grant was compliant, though many athletes are resistant to losing access to social media. His mother said it’s because his ultimate goal is to play professional baseball.
Debbie Page is a huge advocate of ImPACT technology, particularly when a retest showed some abnormalities in her son’s cognitive functioning. “To the naked eye Grant looked fine, but the ImPACT test said no.”
Using the ImPACT, along with clinical examination, Dr. Jones authorized Grant to return to play nearly two months after his concussion.
The IRONMAN Sports Medicine Institute is committed to seeing all Houston area high school athletes take the baseline ImPACT. Already, the Institute has helped athletic trainers at 25 of its partner schools to administer the 20-minute test.
The Memorial Hermann Sports Medicine Athletic Training Outreach Team regularly advises high school coaches and athletic trainers, and makes presentations about concussion management to athletic boosters and youth sports leagues. Each semester, more and more schools are signing up for ImPACT testing. According to leading athletic trainers, everyone wants to offer it to their athletes because it’s the gold standard in concussion management.
William Mosi Jones, M.D., is board certified in physical medicine and rehabilitation and primary care sports medicine. He specializes in sports injury prevention and sports-related concussions, electrodiagnostic medicine and chronic tendon injuries.
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