Concussion Program Helps Student Athletes Return to the Field and Classrooms

By Michael Lasalandra
BIDMC Correspondent

Concussions are finally being recognized for the serious health problem that they are, but now a hospital and health care system in Brockton are working to not only make sure student athletes are okay to return to the playing field, but, more importantly, to their classrooms.

“Its only been in the last four or five years that dealing with the problem of concussions has become mainstream,” says Dr. Ken Lawson of Signature Healthcare and Chief of the Emergency Department and Medical Director of the SportSmart program at Brockton Hospital, which is clinically affiliated with Beth Israel Deaconess Medical Center. “Before that, the seriousness of concussions was overlooked or not well known.”

It is estimated that 3.8 million concussions occur in the U.S. per year during competitive sports or recreational activities, but about half go unreported. Concussions occur in all sports, with the highest incidence in football, hockey, soccer, rugby and basketball.

The issue has gained prominence with widespread publicity over the brain damage that has occurred in many former National Football League players as a result of numerous concussions.

But Dr. Lawson says that sort of concussion damage is not what is concerning him and those who treat student athletes in high school and middle school.

“Those NFL type injuries involve many hits over many years,” he says.

At the student athlete level, it is a matter of recognizing concussions when they occur and making sure the players are okay before they go back on the field so they don’t get a repeat injury that can lead to more serious problems.

More than that, doctors at Signature Healthcare Brockton Hospital are working to make sure kids who suffer concussions get the help they need to get back into the classroom without falling behind.

Concussions cannot be seen on imaging studies so they must be diagnosed using an evaluation tool for cognitive functioning known as the Sports Concussion Assessment Tool or SCAT, a symptom severity checklist and a balance test.

“We worry about direct impact on the head,” says Dr. Dan Muse of the ED at Signature Healthcare Brockton Hospital. “It is also a matter of force on the brain. The brain floats in the skull. You can stop short and the head will continue to move. You can have a concussion without even hitting your head at all.”
 
As a result, he says, there is no way to prevent concussions 100 percent, although helmets help prevent skull fractures and hematomas.

Both Dr. Lawson and Dr. Muse have been longtime school sports coaches in the area. They say the highest numbers of the concussion injuries they see occur in soccer and football and that girls appear to suffer such injuries at higher rates than boys and that their injuries languish longer.

Dr. Muse says knowledge about brain injuries is primitive. “Compared to what we’ve accomplished in cardiology, when it comes to the brain we are still in the bloodletting stage,” he says, only slightly exaggerating. “The brain is the great new frontier of medicine.”

Symptoms of concussion include headaches, nausea, vomiting, nerve issues, sleeplessness, emotional issues and, most importantly, cognitive issues. “Kids can have trouble focusing and remembering,” he says.

But not every concussion causes the same symptoms.

This is where a new program run by Signature Healthcare Brockton Hospital comes into play. It is called SportSmart and it is designed to diagnose the severity of concussion injuries and make sure kids don’t go back on to the field too soon and when they return to school, accommodations are made if needed.

Most states require kids who receive concussions to stay out of games for 10 to 14 days at least. “If they get a secondary concussion before the first one has healed it can be devastating,” says Dr. Muse, who is also program director of SportSmart.

But going back to the classroom is trickier.

“Sports are off the table until the issue is resolved,” he says. “They can take time off sports but they can’t take time off from learning.”

SportSmart gives student athletes from about 15 Brockton area schools a baseline cognitive test, the results of which can be compared to another one given after a concussion. Signature Healthcare Brockton Hospital provides the testing for free and keeps the results on file should a comparison test be needed.

Kids who don’t take the baseline test can be compared to national norms.

The doctors work with local team trainers so that they are able to recognize concussions and order the comparative testing if necessary. After the injury, “the trainers are my eyes,” Dr. Muse says. “They will also go into the classroom and talk to the teachers and see what’s going on.”

Trainers and school nurses involved with the program get continuing education credits.

Many kids with concussions have trouble going back to school. Bright lights will bother them sometimes, as will noisy rooms such as cafeterias. So the schools work to make sure the kids can avoid such stimuli.

Moreover, many kids with concussions find they cannot study without getting headaches. So they may be allowed to skip certain tests or go to school only a few hours a day at first.

“There’s a lot of trial and error,” Dr. Lawson says. “A lot of the schools evaluate them every day. Our goal is to keep advancing them so they don’t fall behind. The school nurses will usually contact us if they have concerns.”

The SportSmart program is one of the first in the area, though such programs are catching on in the state and nationally.

“A lot of doctors and trainers have been trained on concussions, but I’m still amazed at how many have not,” he says.

Rosi Walsh, 17, suffered a concussion in October, 2011 while playing soccer for her school team at Cardinal Spellman High School in Brockton.

She was tripped by a player from the opposing team. “I went off my feet, landed on my shoulder and remember my head hitting the ground,” says Walsh, who lives in Bridgewater. “I rolled over into the fetal position. I was feeling sharp pains and my head ached. I was out of it.”

Fortunately, Walsh had been pre-tested under the SportSmart program at Brockton Hospital so they had a baseline to compare her with. At first, it was thought that she would be out of action only a week, but her symptoms didn’t go away quickly. They included headaches, nausea, vomiting, balance problems, memory issues, anxiety, depression, fatigue, agitation, and sensitivity to light and noise.

In the end, it took 11 months for her to be cleared to return to soccer. “I’m still having memory problems,” she says. “I mix up combinations of numbers. If I’m telling someone to take a right, I might point to the left.”

A former straight-A student, Walsh’s grades plummeted.

She continued to be tested against her first test and against the last test she had taken. She was showing slow improvement. “But I had to completely re-learn how to study,” she says. “I use flash cards and have to write everything down and rewrite it.”

“Dr. Muse helped me so much,” she says, noting that he checked in with her regularly and re-tested her often. He also communicated with school officials so they could take special pains with her, making sure she didn’t have to take lengthy tests, for example.

“Everybody was so understanding and respectful in knowing where it all came from,” she says. “The school people were on board completely. They knew what I could do and what I couldn’t do. Without Dr. Muse’s help, I’m not sure they would have been.”

Dr. Muse even wrote her a letter to attach to her college applications explaining why her grades dropped off last year.

“Everybody was very on top of things,” said Walsh’s mother, Rose Walsh. “With all the testing we could see where she was progressing and where she was having problems.”

She said her son Nick just started playing football at his middle school in Bridgewater and noted that the school joined the SportSmart program just this year. “I was very happy to see that,” Mrs. Walsh says. “Now I know what a concussion can mean. Prior to this, I really didn’t.”

Above content provided by Beth Israel Deaconess Medical Center. For advice about your medical care, consult your doctor.