by Robert Kimmel
In contact sports just a generation ago, a hard jolt to the head and its harmful consequences were mostly regarded as a temporary “time-out” to be followed by a quick return to the playing field. No longer is that the case. “The world has finally caught up with what we’ve known for decades, that head injuries are serious,” said Dr. Ronald Jacobson, a pediatric neurologist in Sleepy Hollow.
From the National Football League to the high school gridiron, greater attention is being given to how head injuries, from concussions to more serious physical damage happening on the athletic field, should be prevented and handled. And concerns have extended to hockey and soccer as well as other contact sports.
The U.S. Centers for Disease Control and Prevention estimates that annually some 200,000 people in the country suffer concussions while playing sports. It has made recommendations on how to deal with the problem.
New York State established a law that took effect in 2012 specifying what should follow for students suffering concussions during a school sport or a gym class. They are required to be sidelined and rest, for at least 24 hours without symptoms, before they can return to the sport. They must also be “cleared” by an appropriate health-care professional. The legislation requires that coaches and certain other school personnel be educated about the symptoms of concussions, known as a mild traumatic brain injury.
Dr. Jacobson, who is affiliated with Westchester Medical Center and Phelps Memorial Hospital Center, is a member of the County’s Concussion Task Force created last year. The Task Force, in January, announced 10 “Best Practices” for managing concussions in high school and youth sports. The Task Force estimates that 10 students in each school suffer concussions annually. Among the “practices” recommended are that schools “build a team” to handle concussions, and that they “assess the situation immediately.”
Increasing numbers of student concussions are attributable to several factors, according to Dr. Jacobson. He noted that “…there are more sports than ever, and more people in sports;” as well as a variety of sports being played during a season; students engaged in more than one sport, with an increase in girls’ sports, and longer seasons, including summer camps, team sports clubs and the like.
Dr. Jacobson credited some Westchester school systems for being “very sophisticated” about the concussion problem. He said that how well the concussion problem is approached successfully varies among the different states. A key at the school level is whether an injured student “returns to learn,” as opposed to “returns to play,” he said. In discussing concussion prevention, he said it has something to do with equipment, but also “with improved coaching and practice models,” not subjecting the players to unnecessary injury. He noted that, “Even at the professional level, they limit contact drills.”
“Not every head injury is a concussion, and not every concussion is just a concussion,” Dr. Jacobson explained. “We have the neck involved, the eyes, the orbits, …so there may be more going on than a concussion.” There are multiple symptoms, Dr Jacobson stated. Among them, he added, “There is the cognitive, attention focus, ability to persevere, the personality aspect, dizziness, headache, vertigo, and visual focusing.” As for a child not participating in contact sports, Dr. Jacobson noted that there is a recommendation coming out that limits contact sports before 12 years of age.
Dr. Jacobson described the subject of concussions as a “…tricky area because it involves the medical field, the athletic entity, schools, trainers, coaches and public policy makers.” So, according to the doctor, you have a greater number of entities involved than for the management of most other health problems. “That is another challenge that needs to be recognized,” he said.
If anyone is admitted to the hospital, following a head injury, Dr. Emil Nigro, Director of the Department of Emergency Medicine at Phelps, explained that the initial task is to determine whether there is no acute emergency going on. “We try to make sure, based on physical examination there is nothing serious that keeps the person, especially a child, in the hospital. But we don’t clear the child to go back to sports. We tell them to rest, and often times they have to follow up with their pediatrician.” Dr. Nigro added, that, “Often times, pediatricians are reluctant to screen these kids to go back to contact sports…and they go on to see a pediatric neurologist.”
CAT scans and MRIs – radiological testing – usually wouldn’t show anything that would indicate a concussion, a temporary brain dysfunction, had taken place, according to Dr. David Harter, a pediatric neurosurgeon associated with NYU Langone Medical Center. It is a matter of analyzing symptoms in determining the difference between a concussion and a more serious brain injury, Dr. Harter said.
However, Dr. Harter noted that there are mild concussions and there are more severe concussions. With an injury related to a severe concussion, “you can have destruction of the brain cells, or disruption of the connections that won’t show up in a scan.”
As for whether a youngster should return to play following a concussion, that decision, he said, should be made by an adult. Dr. Harter explained that there are conditions following an initial concussion that increase vulnerability – what is referred to as a “second impact syndrome” that can cause more serious damage. “We usually recommend a couple of weeks free of symptoms before a return to play. It is a matter of how much risk a family is willing to accept.”
Both the Irvington and the Tarrytown School Districts and the Hackley School have strong concussion management guidelines. Artie McCormack, Irvington’s Athletic Director, and Douglas Sawyer, Hackley’s Athletic Trainer are on the Concussion Task Force in the County.
Charles Scarpulla, Director of Athletics for the Tarrytown District said the district has been following a protocol system for sports concussions developed prior to the State’s legislation dealing with the subject. Scarpulla described it as being very similar to the state’s requirements. He said that a committee including Dr. Larry Goldstein, the school nurse, Bertie Cohen, and sports trainer, Miles Hansen, meet periodically to assess the subject, and they also evaluate injuries.
“This school year, we had twelve athletic head injuries .. most of which were from girls soccer. Others involved football, boys’ soccer and basketball. There was a return to play protocol, for which we spent two hours testing each student.” Scapulla related. “Everyone has to take the impact test.” The symptoms are analyzed by the School Doctor, Larry Goldstein, and our trainer Miles Hansen.” If there are no symptoms, light exercise is prescribed for the second day, Scapulla said. If there are no symptoms by the third day, he said, they are allowed light practice. On the fourth day, after evaluation, for football, as an example, they work with light contact, according to Scapulla.
To watch for possible injuries, “Our trainer is on hand at every sport’s home game,” Scapulla noted. “We are much more aware, much more concerned, and I feel very strongly that schools in this area are doing what they have to do to curtail concussions and injuries.”