Concussion Safety Takes Priority at Rye Schools

Rye Country Day School Director of Physical Education and Athletics Frank Antonelli is willing to joke about how concussions were treated when he played football, but he takes the issue very seriously today.

"I'm 65. I played football in college," Antonelli said. "I got my bell rung a lot. When I mix something up, I blame it on the hits. The subject wasn't even broached at the time."

Times have changed and the culture of football and other sports is changing with it. Congress has been looking into the issue of head injuries and considering setting national standards for their treatment. The National Football League is facing more pressure than ever to protect its athletes from concussions, as evidenced this past season when high-profile quarterbacks Kurt Warner and Ben Roethlisberger were forced to sit out games due to concussions.

"Injuries to Roethlisberger and (former Philadelphia Eagles running back Brian) Westbrook elevated the attention and people are taking it seriously," said Rye Country Day School Athletic Trainer Steve Norman, who is in his 16th year at the school after spending 11 years at Columbia University. "That wasn't always the case. With the adolescent brain, it is still developing, so (the effects of a concussion) can be worse."

According to the Brain Injury Association of America, there are between 1.6 and 3.8 million concussions suffered in the United States each year due to sports or recreational activities. Multiple concussions can be particularly dangerous, especially in young people who are still growing.

"To me, the most important thing to understand is that concussions are a part of life and sports," Norman said. "There are car accidents or somebody can just be fooling around. They are going to happen. It's how you manage them that [is] the real issue."

Making an Impact

With that in mind, Norman brought the ImPACT Program to Rye Country Day five years ago. Rye High School began using the same program in July 0f 2009.

"We knew we had to do more to keep kids safe," said Rob Castagna, Rye Director of Health, Physical Education and Athletics. "We heard a lot about it and read the literature. We had kids suffer concussions. We decided to do the right thing. Rye Country Day School has had this for a few years. We followed their lead. "

ImPACT is a computer-based program in which the athletes take a baseline test to determine their normal brain function. In the case of a brain injury, the tests are administered again to determine the severity of the injury and later to find out if they are ready to return to their regular activities.

Both schools have procedures in place across all sports from grades 7-12. Concussions are most often associated with football, but they are a danger in all sports.

Rye High School girls soccer coach Rich Savage, who has also coached the boys in the past, pointed out that soccer may have even more concussions than football. He was pleased by the addition of the new program.

"Soccer has a high number of concussions," Savage said. "[When] Kids go up for a header the goalie will come out to punch it away, and they will take a punch or an elbow to the head. Or a keeper comes out to make a tackle and gets kicked. When you are putting the safety of the athletes first, you are doing the right thing."

Changing the Culture

Trainers at all levels are taking more cautious approaches than in the past.

"You would have to be foolish to ignore all the scientific research that's out there," Castagna said. "Any school or coach would not be doing their best if they ignore all that has been written recently and all research out there. It doesn't hurt anyone to have this in place. If kid sits another game, so be it."

Both schools insist that student-athletes are asymptomatic before returning to normal activities. They also want to see athletes tests on ImPACT and return to the baseline level.

Norman explained how the entire procedure is handled at Rye Country Day. Balance tests and short-term memory tests are still used on the sideline if a coach or trainer suspects that an athlete may have suffered a concussion. If there is any doubt, they are out of the game. If they lose consciousness, they go to the hospital. If not, they and their parents are told what symptoms to look for and if things worsen, they can be taken later to a hospital, Norman said.

Most concussions, as many as 90 percent in some estimates, occur without any loss of consciousness. Symptoms include nausea, dizziness, a lack of balance, blurred vision, headaches, confusion and feeling sluggish or groggy. Regardless of the symptoms or recovery, Norman insists that student-athletes who suffer a concussion see a doctor, though they must pass the school's standards to return to activity even after they have been cleared by their physician.

Returning to activity goes beyond athletic competition. Norman said that students are also kept from returning to class until they are sufficiently recovered.

"Research shows that a rigorous academic program can stress the brain and delay the recovery," Norman said.

The student-athlete is not allowed to exercise at all until he or she is asymptomatic for seven to 10 days. Then they have to pass the ImPACT testing and a post-exertion test. If all is normal, they slowly work their way back in with their teams. Each recovery is different, so timetables can vary.

"Almost always, we are looking at a three-week minimum," Norman said.

Norman also said that his own experience and the current research both show that female athletes are more susceptible to concussions than their male counterparts, though the exact reasons for the differences are not yet known.

Norman credited the support he has from the school for the ability to protect the student-athletes. One key is making sure that the student-athletes understand the importance of being honest when reporting their symptoms. That is one area in which ImPACT testing helps, because they cannot trick the test.

"If a kid takes [a] shot, the last thing kids wants to do is tell anybody," Antonelli said. "[Norman] will show you the consequences through education. Here is what can happen over time. Look down the road. It's a matter of educating the kids, too, so they have confidence in what we're doing."

Savage said that coaches have to look out for the warning signs of a head injury and always err on the side of caution.

"I think there is a real responsibility as a coach to take it into consideration," Savage said. "There is a competitive drive within coaches and athletes, but you have to step back and evaluate it to make sure they are fine."

The results if athletes, coaches and trainers do not take proper precautions can be disastrous. The potential damage when a concussion is not treated properly ranges from longer-term debilitation to permanent brain damage, even death.

One reason the spotlight has shone on the NFL is a long history of athletes suffering long-term mental disabilities due to concussions. Athletes who return to competition without allowing a concussion to fully heal are at a dramatically higher risk of permanent injury. Former NFL fullback Merill Hoge, now an analyst with ESPN, nearly died in the locker room and suffered some long-term memory loss when he took a second hit before a first concussion had completely healed when he was playing for the Chicago Bears.

According to the Centers for Disease Control and Prevention, deaths from sports-related concussions are very rare, but in almost every case a previous concussion had occurred before the fatal blow. The brain swelling that occurs when there is a second concussion before the first has fully healed is called second-impact syndrome.

Norman said that if treated properly, a student-athlete should make a full recovery from a concussion.

"I think it is important for everybody to understand the seriousness of it," Norman said. "If you sprain an ankle, you still have another one and it will get better. You have one brain and it's not so easy to fix when you have major problems."

For further information, see the following websites.

http://www.biausa.org/elements/BIAM/2009/2009_sports_concussions_fact_sheet.pdf

http://www.cdc.gov/Features/ProtectYoungAthletes/