Friday, October 14, 2011

Orthopaedic Rehab Specialists 'ahead of the curve' in helping treat athletes with concussions

Concussions suffered by athletes at all levels are coming under increased scrutiny, but it’s nothing new for high school athletes in Jackson County.

Five years ago, Orthopaedic Rehab Specialists of Jackson began using a concussion evaluation system to help treat high school athletes who suffered brain injuries.

Known as ImPACT testing, it is now in place in all but one Jackson County high school. Everyone else is trying to catch up — this summer, Dick’s Sporting Goods announced a promotion aiming to raise money to get the testing introduced at 3,300 schools throughout the country.

“We’re ahead of the curve,” said Amy Chamberlain, director of administration and sports medicine at Orthopaedic Rehab Specialists.

The testing has resulted in a major change in the way athletes who suffer head injuries are treated.

“This year, we’ve had six kids sitting out,” Jackson football coach Jack Fairly said, “and in the past none of them would have sat out, because none of them lost consciousness. The old way, if you got knocked out, it was serious.”

Now, coaches, trainers and physicians are more cautious and are able to better gauge the seriousness of a head injury thanks to ImPACT (Immediate Post-Concussion Assessment and Cognitive Testing).

No one knows that better than Sullivan Evans, a Lumen Christi High School sophomore who suffered two concussions last year playing freshman football. The first one occurred after a helmet-to-helmet hit in the season opener.

“The ImPACT test proved it (was a concussion),” said his mother, Kristin Evans. “He said, ‘Now that I know what that feels like, I bet I’ve had six of those playing hockey.’ ”

It took four weeks before Sullivan’s ImPACT test scores showed he was ready to return to action. Then in his first game back, he suffered another concussion. This time, it was six months before he was cleared to play contact sports again.

What’s involved with testing

ImPACT actually begins before a player puts on a helmet — or takes the field in other sports. What is known as a baseline test is administered to Jackson County athletes in all contact sports, including track athletes such as hurdlers, jumpers and pole vaulters. They are tested as freshmen and again as juniors because of the rapid development of the brain during that time.

“We call it a physical for your brain,” Chamberlain said.

The test is completed online and takes about 20 minutes. The six parts of the test provide a baseline for each athlete’s reaction time, attention span, problem solving, processing speed, and immediate and delayed memory.

For example, athletes are shown a series of words. Then another series of words is displayed, and they are asked which of those words were in the original group. The same thing is done with designs. Other parts of the test ask the athletes to click on certain keys when certain shapes appear on the screen and to click on the numbers 25 through 1 backward as they are displayed randomly.

“It shows what’s the norm for that student in how they process information,” Chamberlain said.

Athletes who might have suffered a concussion see a physician immediately. Within 24-48 hours, they retake the ImPACT test. Only if their scores in all six areas of the test are comparable to their original test are they deemed fit to return to competition. If not, they are retested every three to five days until their scores are acceptable.

The aim is to prevent the cumulative effects of concussion and avoid a second concussion while still recovering from the first, which can have catastrophic consequences, including death.
Chamberlain said the test is not perfect, but it is recognized as the most scientifically valid system for evaluating concussions and is used by the NFL, NHL and Major League Baseball. It is used in conjunction with the symptoms that trainers and physicians observe.

“Where it helps is, kids don’t want to be honest,” Chamberlain said. “Everybody wants to be out there playing. They know they’re likely to have to sit out at least a week, so they’ll lie (about symptoms).”

But there is no fooling the test.

And that goes for athletes who intentionally provide low scores on the baseline test in anticipation of a comparison in the future.

“We’ll know,” Chamberlain said. “The system will flag a test that is below the norm and let us know. We can have them tested again.”

The impact of concussions

She said that is occurring less and less as athletes learn of the repercussions of concussions. It goes far beyond the playing field. Judgment and impulse control can be affected, and depression — serious enough to require hospitalization and in some cases leading to suicide — can be triggered by a concussion.

“You still worry about that kid who is an overachiever and won’t tell you he’s had his bell rung,” Fairly said. “He wants to play. I don’t know how you stop that. The next step is to educate the kids.”

The Orthopaedic Rehab trainers have been trained on ImPACT at the Pittsburgh Medical Center, home to the doctors who developed the program. One of them came to Jackson last year to provide an advanced training session.

The testing is important because research is showing that concussions should be treated as individual cases, Chamberlain said. Orthopaedic Rehab has tested about 8,000 athletes as part of its contracts with local schools. Last year, 289 were diagnosed with a concussion, more than 100 of them football players.

So far this fall, 89 athletes have suffered concussions, and Chamberlain said every school in the county had at least one football player out with a concussion for three to four weeks.

Chamberlain said the ImPACT testing was met with some skepticism by coaches when introduced at four schools here in 2006. There is little resistance these days.

“I’m OK with it,” Fairly said. “I want the safety of the boys. It’s a game.”

There are also parents who don’t comprehend the seriousness of concussions and believe their athletes are ready to get back in action when they feel better.

“Before the tests show that, that is where it gets sticky,” Chamberlain said. “Most parents accept what the test says. We do our best to explain why we rely on it.”

There was no need to convince the Evans family. Kristin Evans — who credits teachers at Lumen Christi and Carrie Stevens, the Lumen Christi trainer from Orthopaedic Rehab Specialists, for identifying her son’s symptoms and helping him as he recovered — said the rest of the school year was difficult for him after his second concussion.

That is why he made the choice not to play football this fall.

“He misses football,” she said. “But not enough to be brain damaged.

“If (Orthopaedic Rehab Specialists) wasn’t there, where would we be? It’s happening and kids don’t even know it. They’re saving kids’ lives. They won’t realize it until they’re older.”

Read the article on MLIVE here

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