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Health experts stress recognizing, treating concussions properly

When Tedd Girouard became a certified athletic trainer in 1995, concussions weren’t always treated with the sophistication that they’re treated with today.

“In 1995, nothing was like what it is now,” says Girouard, director of the athletic training program at the University of Nevada, Las Vegas. “I’m a professor now, and I tell my students, ‘If I would deal with concussions the way they did 20 years ago, I’d be sued.’ “

Thanks to several high-profile concussion cases in the NFL, trainers, coaches, parents and even players at just about every level of sports today are keenly aware of the risks concussions pose. And while football tends to be the sport most associated with the injury, Girouard wonders whether it “has gotten a bad rap.”

For instance, he says, “there’s a big push going on right now in youth soccer, particularly, to not teach heading and not allowing the heading of the soccer ball at certain ages.”

A concussion occurs when the brain is forced against the skull by an impact from another player, the ground or another object. Think of the brain as having the consistency of gelatin and moving within the boxy confines of the skull, suggests Dr. Charles Bernick, associate medical director of the Cleveland Clinic Lou Ruvo Center for Brain Health in Las Vegas.

“So if it’s put into motion in the skull … that motion is either linear, front to back, or rotational. And as the brain moves or is rotated in the skull, you stretch billions of fibers that cross the brain, injuring them, and that leads to almost immediate chemical changes.”

So, a concussion is the resulting “transient impairment of the brain or neurological functions due to a blow to the head,” Bernick says, causing an array of either obvious or more subtle symptoms that can include headache, nausea, vomiting, dizziness, a sense of feeling stunned or dazed, an inability to focus, and not being able to recall the event just experienced.

“It can take many forms,” Bernick says. “And, of course, a person could lose consciousness, but that’s probably at the more extreme end of the spectrum.”

A 2007 study estimated that about 300,000 sports-related traumatic brain injuries, most of them concussions, occur annually in the United States, and sports falls behind only motor vehicle crashes as the leading cause of traumatic brain injury.

Sports-related concussions aren’t restricted to college and pro athletics or other elite levels of sport. Dr. Paul H. Janda, a board-certified neurologist with Las Vegas Neurology Center, says it’s estimated that “there might be 100,000 concussions in high school athletics every year, and the sport, most certainly, to watch out for is football. But, after that, it would be followed by soccer and basketball and, then, to round it out, usually data will show wrestling and maybe even softball.”

Girouard says the effects of a concussion typically last seven to 10 days, although some athletes can feel their symptoms for weeks or even months.

“The ones that can last longer are really frustrating,” he says. “Personally, I’ve had two athletes I’ve dealt with (who had effects) four to six months, but, on initial evaluation, they looked like standard, typical conditions that just never got better.”

Because some concussion symptoms can present subtly, athletic trainers on the sidelines use a variety of tools that assess a player’s coordination, cognition, balance and memory.

“That gives us a rapid indication of basic signs and symptoms,” Girouard says. “Then we … test things like balance, we test gait — how they’re walking— and we may do a neurological exam. It can get pretty deep. We do eye tracking and test hearing. So it’s like solving a puzzle with all these moving parts.”

A significant change in managing sports-related concussions comes from laws passed in most states, including Nevada, that establish protocols that kick in when a high school player sustains a concussion. According to the U.S. Centers for Disease Control and Prevention — which has mounted a “Heads Up” campaign to teach athletes, coaches and parents about concussions — the laws typically include an educational component, as well as requirements that a concussed athlete be taken off the field and not return to play without medical clearance.

“In ’95, we would reevaluate them 15 minutes later,” Girouard says. “if it appeared they did not have a concussion, we’d put them back in.

“That absolutely doesn’t happen anymore. If someone sustains a concussion, they’re, minimally, out for one day and, realistically, we’re looking for seven to 10 days as the guideline now.”

And, Janda says, today’s treatment rule of thumb is — or should be — “when in doubt, sit it out.”

“The main thing, in terms of treatment, is to remove (the player) from the activity,” he explains. “Our group sees many patients from the UFC and other athletes, and what we recommend is for patients to be removed. Then, we have gradual introduction back into it.”

Meanwhile, research continues to unravel the potential effects concussions, and successive concussions, might have on the brain. For instance, the Cleveland Clinic is involved in a program with the NFL Players Association, while Bernick and the Ruvo Center are conducting a study about the potential association between the blows professional fighters take and such conditions as chronic traumatic encephalopathy.

While contact sports always will involve a risk to participants, Bernick says risks to the brain can be reduced by such actions as limiting practice or play time for concussed athletes and implementing rule changes that prevent potentially harmful contact to the head.

“For example, there may be a certain number of fights a person can have a year — you need to let the brain recover for a certain period of time before you go again. There may be ways to screen individuals who might be at higher risk for developing injury due to repetitive concussion. So I think as we learn more, we can implement better policies that add safety to the sport,” Bernick says.

For now, Bernick says, parents of young athletes should educate themselves about concussion — what it is, symptoms, and protocols that are to be followed after one is sustained — and make sure that coaches and others who supervise their children are trained, too.

“I think the main thing is making sure those who are responsible for the student — coaches, trainers, administrators — everybody is really educated and on-board and really looking out for these kids,” Bernick says.

— Contact reporter John Przybys at jprzybys@reviewjournal.com or 702-383-0280, or follow @JJPrzybys on Twitter.

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