Football season is in full swing at local high schools. Americans enjoy watching or playing football, but the harsh reality is that athletes do get injured, and concussions are one of the most common injuries seen.
A concussion is a traumatic brain injury caused by an impact to the head. The impact jars or shakes the brain inside the skull, which can cause brain injury and swelling. Damage to the brain can be increasingly serious if someone has multiple concussions. When a student athlete has a potential concussion, it is essential that he or she is correctly diagnosed and appropriately treated before they can be medically cleared to return to play.
Hugh Chatham Memorial Hospital has provided free baseline concussion assessments to varsity football players and other athletes at four Yadkin Valley area high schools, including Elkin, Forbush, Starmount and Surry Central. The service began three years ago at Elkin High School, and has expanded over time to include the other high schools.
Representatives from Hugh Chatham go on-site to the schools to administer the computerized baseline test. The screenings are pre-arranged with school administrators and coaches, and parents sign a consent form. Hugh Chatham uses the ImPACT screening test, which stands for Immediate Post-Concussion Assessment and Cognitive Testing. This scientifically validated test is used by the National Football League, as well as by the U.S. military and thousands of colleges and high schools across the nation. The student-athletes sit at a computer and read and answer questions that require them to do simple and complex thinking tasks such as sorting objects or playing memory games.
“Having a baseline concussion test is like having insurance,” explained Dr. Steven Meadows of Hugh Chatham Neurology. “As a preventive measure, a baseline test is typically taken prior to a sport season when an athlete has not yet started training or competition.
“If a concussion happens during practice or in a game, the same test (a ‘post-injury test’) can be taken again by the athlete, and doctors can compare scores from before and after the injury,” he explained.
The baseline and post-injury test may then be used by medical professionals as additional information to help guide the student athlete’s evaluation for returning to the classroom and to athletics. He explained that if no concussion occurs during the sports season after an athlete has taken a baseline screening test, the test doesn’t have to be repeated annually, it can instead be done every other year.
“It’s not always easy to know if someone has a concussion — you don’t have to pass out or lose consciousness,” explained Meadows, who said that symptoms can be mild or severe. Symptoms may not appear immediately, but rather over the following hours or days, and can last for hours, days, weeks or even months.
Meadows explained that concussion symptoms fall into four main categories:
• Difficulty thinking and remembering
• Physical symptoms, such as blurry vision, dizziness, headaches or nausea
• Emotional changes, such as feeling easily anxious, moody, sad or upset; and
• Sleep problems, such as difficulty falling asleep or sleeping more or less than usual.
Meadows said that when a concussion happens, it is important to measure how well the brain is functioning post-injury. He explained that knowing this information can help to plan an effective rehabilitation program for the athlete, customized to their needs based on the type and extent of the injury. During the post-injury assessment, the computer records the students’ ability to correctly answer questions as well as the speed of their responses and generates a comparison report to the baseline assessment.
“When you have a concussion, you cannot complete thinking and problem-solving exercises at the same pace as individuals who do not have a concussion,” explained John Orta, DPT, director of Rehabilitation Services at Hugh Chatham Memorial Hospital. “Moreover, each concussion is unique, so it’s important to treat individuals on a case-by-case basis.”
Hugh Chatham providers who are seeing and treating local area athletes have all completed the CDC’s concussion training program, “Heads Up” and are compliant with the North Carolina High School Athletic Association (NCHSAA) guidelines.
Doctors volunteer on the sidelines, too
Hugh Chatham’s offering the free baseline concussion tests started when Dr. Jonathan Snyder of Tri-County Orthopedic & Sports Medicine, a specialty medical practice affiliated with Hugh Chatham, was discussing with Orta about how they could make sure that the football players at Elkin High School were receiving the best preventive care, not just post-injury health care.
Snyder and Orta work together as volunteers on the sidelines to assess and treat injuries for the high school’s varsity and junior varsity football teams. It’s something that Orta has done for 15 years. “I was kind of recruited to do it by Dr. Skip Whitman of Tri-County Orthopedic & Sports Medicine, who was doing it before me. When I started, my son was just 1-year old, and now he’s in high school,” Orta said.
He explained that when a player is suspected of having a concussion, he or Snyder will ask the player simple questions such as do they know where they are or what they had for lunch today to make them think. They also use a flashlight to check the athlete’s pupils and to see if he or she can follow a finger with their eyes. “If we recognize that an athlete isn’t doing well, we can activate a more detailed screening protocol,” he said.
The decision of whether or not to pull a player out of a game until they can get appropriate follow up care is made following NCHSAA guidelines. If a concussion is suspected without any signs of needing immediate emergency care, the next step can be to have the player assessed by a provider at the Urgent or Express Care, in addition to completing a post-injury test utilizing the IMPACT system.
Ideally, the post-injury ImPACT test should be conducted 24 to 72 hours after the injury. A provider will assess the player’s ImPACT scores, their signs and symptoms, and conduct a physical exam. Referral may then be made to a specialty office such as Hugh Chatham Neurology, to the player’s primary care provider, or to begin a return to play protocol with a trained professional such as Orta.
Orta, who has a doctorate degree in physical therapy, explained that the North Carolina High School Athletic Association has very specific rules and protocols that high schools must follow before an athlete can be medically cleared to return to the classroom and to return to play. Orta says that he starts the player with light aerobic activity and exercise on the first day; moderate activity with moderate strength and weightlifting on the second day, then on third day higher capacity aerobic and strength activity. On the fourth day, the player might be ready to do a controlled practice with no contact before participating in a controlled contact practice on the fifth day if he or she is not any of the signs of the concussion. The athlete will then by re-checked by a provider with concussion management training before being released to return to play.
“When an athlete is suspected of having a concussion, Hugh Chatham’s experienced medical team is ready to respond with a step-by-step plan and smooth coordination among the different physicians and providers doing different jobs,” Orta explained. “Our team will be there for your team, or for your athlete, when you need us.”