School Policy Update: Tracey Mayer

Parent Advocate, Tracey Mayer will be offering up her writings to The Concussion Blog as a resource to the readers, especially the parents out there.  As time allows she will be submitting posts for you to read.  I truly hope that everyone gets a chance to read about concussions from yet another perspective.  Thank you Tracey!

I recently met with one of the Vice Principals at Drew’s high school for a non-concussion related matter.  During our conversation, the topic of concussions came up because he is aware of what Drew has gone through, and he was asking how he is doing.  He told me about two female athletes who both suffered fairly significant concussions recently.  He said they were really struggling academically, which was such a perfect opportunity for me to enlighten him about the policies put in place in Prince William County, Virginia.  I sent these policies to the Superintendent Continue reading

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ATSNJ Survey

Below is an email from the ATSNJ that I feel needs to be posted to create more dialogue.  New Jersey, the ATSNJ and Eric Nussbaum have done a fine job of leading the way in this issue at the high school level.  Thanks for the note.

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Dustin,

From the Athletic Trainers Society of NJ, completed in November.

NJ was one of the first states to formally pass a concussion law in December of 2010.  Our concussion law accomplished several things.  a) directed our department of Education to develop a model concussion policy and instructed ALL districts to implement a formal concussion policy by September 1, 2011.  b) Mandated concussion education for all licensed athletic trainers in the state.  This makes us the only healthcare profession with mandated continuing education in concussion care, making athletic trainers concussion “experts”.

We had heard that many schools were having some issues formulating/implementing a formal program for their districts.  There were several questions that were not well-defined in the law or model policy put out by the DOE.  Key terms like: “trained in the management of concussion”, “asymptomatic”, “academic accommodations”, specific education and RTP guidelines were all issues that districts needed to consider for their policies.

The ATSNJ put together an online survey and sent it out to our secondary school ATs.  We had 110  secondary schools with an LAT respond to the survey.  (about a 33% return)

We conducted the survey to: a) see how many schools actually were implementing a board approved policy. b) find out if terms were being defined c) find out about consistent issues w/ policies d) determine what source of information schools were using to develop their programs d) determine who was responsible for education, notification, coordination and implementation of actual policy.

The highlights of the results were posted in our release, HERE;

  •     Only 63% of team physicians are “trained in the management of concussions”
  •     9% of respondents do not have a board approved concussion policy.
  •     27% of schools adopted a generic policy.
  •     84% of districts do not define “trained in the management of concussions” in their concussion policy.
  •     51% of districts do not define “asymptomatic” in their concussion policy.
  •     60% of districts do not define specific academic accommodations in their concussion policy.
  •     89% of school policies define “graduated return to play protocol”
  •     100% of districts utilized athletic trainers as the gatekeeper for the concussion management process

We also developed a policy check list that schools and parents could utilize to evaluate each schools policy.  We have posted suggestions for definitions and improving policies on our website, HERE.

We realize that development of a good working policy may take time and a little tweaking.  The ATSNJ wants to be a resource for parents and schools as they develop their individualized policies.

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Feedback is encouraged by commenting below.

The Hardest Part Of My Job

As an athletic trainer there are many difficult situations that arise on the job.  Broken bones, overzealous parents, concussions, weather and a myriad of other things get to you.  However, there is nothing more troubling and depressing than what I just had to do.

Back story is a female basketball player who has sustained multiple concussions over her high school years in various sports/activities.  Each one was handled to the best of our ability and under the concussion policy at this school, even had great conversations with the MD on the case.

After her last concussion, last December, we discussed that because of the number (then at 4) for her the resolution would be longer and possibly met with more difficulties.  We also discussed that if all her care takers; parents, coaches and Continue reading

School Getting Smart

From the Globe and Mail (Canada), St. Micheal’s College School has developed a return to school program from concussions.  As we know return to the classroom and the school environment can be just as harmful as rushing back to sports.

“There’s a lot of focus on the return to play but not on the return to the classroom, where the kids can have a number of difficulties due to their brain injury,” said Corinne Kagan, a program director at the Ontario Neurotrauma Foundation.

The classroom demands that students listen, learn and think, all of which involve brainwork. Some of the symptoms of a concussion, such as headaches, dizziness and trouble concentrating, can make this even more difficult.

What St. Michael’s has developed, Ms. Kagan said, is “a very good thing.”

I have been promoting this from the beginning here on the blog.  In fact the school I work with adopted a policy that deals with this exact thing.  I believe it to be the first of its kind in Illinois.  Simply we educate the athlete and parents about the injury and proper management; with that the school is suggesting and allowing students to be excused for up to three days before seeing a doctor.  Upon return the student will work with the guidance counselor, teachers and myself for a simple graded return to classroom activity.  Since each person is different in recovery there is nothing set in stone for academics.  We do have an understanding that if the student misses quizzes/tests they will not make up more than one a day until full recovery.  Homework is often allowed to be turned in on a “graded return”, and classroom performance is monitored by the teacher.

This is not required of the student or parents, rather a recommendation and not every kid that gets a concussion follows our guidelines.  However my limited sample size shows some serious results (based on concussions from January 2010 to present): Continue reading

Live From Princeton

Welcome to the continually updated live feed from the Athletic Trainers Society of New Jersey 2nd Annual Concussion Summit.  I would like to thank the ATSNJ in particular; John Furtado, Eric Nussbaum, and Mary Jane Rogers for the help in getting things set up.  We are at the Wyndham Princeton Forrestal Conference Center & Hotel in a stunning amphitheater, attendance is anticipated to be high.  I anticipate updating this post as soon as possible after each speaker.  Follow @concussionblog for updates.

6:25am CST: Crowd flowing in with provided breakfast in hand.

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6:33am CST: Jason Mihalik, PhD “Biomechanics of Concussion”;

  • Concussion is a FUNCTIONAL injury not structural injury
  • Brian injury a major public health concern (showing a pyramid with the head injuries on the bottom, unseen or caring on their own)
  • Things that feed into Traumatic Brain Injury:
  • Cognition, Concussion History, Postural Stability, Mechanism of Injury, Physical Exam, Symptomatology, Knowledge/Attitude
  • Injury Prevention (anticipation, infractions, play type, closing distance)
  • Kinds of impacts that cause concussion; research obviously done primarily on animals beginning in the pre 40’s.  The coup-contracoup model was found by using animal models
  • Research moved from animal models to human analogs; wax skulls/gelatinous brains Continue reading
  • New Jersey Concussion Summit

    The Athletic Trainers’ Society of New Jersey is hosting its second annual Concussion Summit on July 17th.  It is after the “early registration” however the line-up is certainly worth a look.  This is the same organization that produced the very well put together tutorials on concussions, SEE HERE.

    • Steve Broglio, PhD, ATC – Assessing Balance in Concussion
    • Robert Cantu, MD – Long-term Effects of Concussions
    • Annegret Detwiler-Danspeckgruber, EdD – Imaging Concussions: DTI and fMRI
    • Ruben Echemendina, PhD, PSY – The Role of Neurocognitive Testing
    • Jason Mihalik, PhD, CAT(C), ATC – Biomechanics of Concussions Continue reading

    Live From Lexington

    Welcome to the intended live feed from the 2nd Annual Sports Concussion Summit here in Lexington, Kentucky.  We are at Cardinal Hill Rehabilitation Hospital, a beautiful facility.  Attendance looks to be very good, about “60 or so” according to Jonathan Lifshitz, host of the event.  I will be updating this post as we go along with a time, follow @concussionblog on Twitter for updates.

    7:05am CST:  Jonathan Lifshitz, PhD opens up the conference, a big “walk-in” group, I still think I may be the only one not from KY here.

    7:10am CST: Dr. Lifshitz had a great perspective on announcers and how the terminology of the game regarding head injuries has to slowly begun to change.

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    7:50am CST: Dan Han, PsyD “Contemporary Perception on CHI: Multidisciplinary Initiatives

    • 1.7M documented TBI; 52,000 deaths per year, 275,000 Hospitalizations (CDC Numbers)
    • 75% of TBI (1.3M) are concussions/mTBI/mDAI; 300,000 are DOCUMENTED sports concussions
    • 0-4, 15-19 and 65+ y/o’s most likely to sustain a TBI
    • Females have significantly higher odds of poor outcomes
    • Documented TBI (see above) not the real issue; the undocumented TBI is the proverbial iceberg under the water
    • Diffuse Brain Injury
    • Secondary to stretching forces on the axons
    • Moderate DAI = “Classic Concussion” (unconsciousness, possible basal skull fracture)
    • Persistent confusion, retrograde & anterograde amnesia, mood/personality changes
  • Severe DAI = Brainstem Injury (high mortality rate)
  • And TCB Contributor Tracy Yatsko gets some run on a video!!!  Man girl you get around :)!
  • Postconcussional Disorder
    • LOC > 5 min or anterograde amnesia or new onset of seizures within 6 months after CHI
    • Just learned a lot about seizures; many go unnoticed
  • AND attention or memory deficit
  • Plus 3 or more symptoms present for at least 3 months following CHI
  • Significant impairment in social or occupational functioning
  • Academic achievement decline
  • HUGE Multidisciplinary Concussion Program at University of Kentucky, well on the way to being a leader in concussions
  • —–

    8:50am CST: Greg Wheeler, MD “Treatment of Sports-related concussions and return-to-play clearanceContinue reading

    Kentucky Sports Concussion Summit

    The 2nd annual Sports Concussion Summit in Lexington, Kentucky is set for June 24th.  The event is set to be a good source of information and a provider for continuing education, especially for athletic trainers (although anyone that will be dealing with concussions is CERTAINLY encouraged to attend);

    The 2nd Annual Sports Concussion Summit will feature experts in the field of clinical practice dealing with the prevention and management of sport-related concussions. This conference is designed to review current practices in the prevention, recognition of concussions, and management of sport related concussions. The conference will benefit health care professionals involved in all levels of care and training, as well as athletes, coaches, and parents.

    The summit is presented by; Continue reading

    Very Gratifying Day

    I have blogged multiple times about the concussions that I have dealt with in my job.  They are from the obvious to the “right place at the right time”, but finding them is the easy part.  In fact it is becoming much easier at the school I work with as more and more have “bought in” to the system.  Parents, teachers and kids themselves are letting me know about possible head injuries, it is not so taboo around here anymore.

    One of my most recent episodes occurred with a pole vaulter, who refused to come to me only basically dragged in by his mother after seeing the blog and knowing what was going on.  His evaluation was straight forward and was definitely concussed, but after 15 days of adjusted scheduling (rest, away from school, graded return), fish oil and listening to our advice he was back to perfect.  In fact his post ImPACT was better than his baseline, but what was even more evident was his demeanor and general disposition, he looked like him again.  He is going to stay out of contact sports for another two weeks before beginning football activities.  A success!

    However, this is not the point of my gratifying day.  Remember this day for me and the Continue reading

    Specific Academic Issues From Concussion

    This is the next level of adolescent concussions, the classroom.  Thankfully at the school I work at we have created a policy to keep kids out of school and amend their schedules as needed, but others refuse to believe it trickles over into academia.

    Even the CDC does not have specific recommendations about school, rather they defer that to the treating physician, which is perplexing because A LOT of MD’s/DO’s are behind the times to begin with.  Those medical professionals are looking to the CDC for what to do, it would be nice if the CDC and others presented guidelines.

    It would be as simple as saying; “rest includes avoiding any physical or cognitive stress, for example; school, texting, computers, and video games.”

    That Was Quick

    I am a relative noob when it comes to blogging/journalism “light”; being hopeful this blog had and will have an impact seemed naive at best, guess I have been deemed wrong again and again and again…

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    Remember my post about Chicago moving an ordinance along about concussions?  (It is just two below this one)  And how I pretty much screamed for the state legislature to get the move on, even inviting an email for any needed guidance… I didn’t get an email…  But I did get a phone call, again from a source wanting to remain unnamed (seems to be a pattern with this unnamed sources recently) letting me know that there is a push for this issue and that the Chicago ordinance caught EVERYONE “flat-footed”.  There will be something “soon” I was told.

    Good, and thank you for visiting The Concussion Blog!

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    A fellow athletic trainer recently emailed us to tell me that he has been following since Post 1.  He figured we were going in the right direction and used it as a resource but figured, like myself, that it’s a blog and it has its limits.  He was wrong and so am I, as his medical director asked him about it and shared with him that the stuff we are putting out is good and very informational.

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    Dr. Broglio of the University of Illinois wanted to let everyone know he is very thankful for your participation in the research and that the audience of The Concussion Blog has been and will continue to be very, very helpful in further projects!

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    As an information “nerd” I like to see our website stats, not so much how many people are visiting but seeing who is linking this information, and would it shock you, as it did me, that; Sports Illustrated, Deadspin, ESPN, Uniwatch and loads of message boards (shout out to Illinois High School Sports.com) have linked us?  Just hope the later of those are not tearing us to shreds too much!

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    This leads me to a simple…  Thank You!  And keep all the information coming, everyone can participate in this experience…

    USA Today Article

    Kelly Whiteside, writing for the USA Today, put together a great article discussing what we believe is the most important aspect of concussion recovery – return to school and academia.

    Brianna is a typical high school athlete, not a future college star, just a kid whose life revolves around the sport of the season. Her story has become all too familiar. She was medically cleared to return to sports too soon and continued to take a full course load at school. The mental demands of the classroom slowed her recovery as well. Addressing the roomful of her peers on this November evening, Brianna describes what life has been like since suffering her first concussion in February when she took a knee to the head during a basketball game.

    “It’s been nine months, and I still have headaches every single day I wake up. I don’t want to go to school. I barely get out of bed. My mom is constantly trying to get me up, and I just don’t want to get up. I’m late for school, which is no fun. I get really dizzy when I get up from a chair, and I am also tired all the time. I sleep for 16 hours, and I’m still exhausted.”

    What is also typical of Brianna is that those that have been concussed across the nation are experiencing the same thing she is, but Continue reading

    Eastern Illinois Article

    Alex McNamee of the Daily Eastern News, the campus newspaper for Eastern Illinois University in Charleston, Illinois ran a story today about “Hank”.

    Hank said he has no recollection of 12 hours before the concussion or the 12 hours after the hit during summer preseason training in August.

    “You say weird things, act weird, then go to sleep,” Hank said.

    But sleeping is difficult, as he lies in bed trying to count sheep but cannot get past the heartbeat in his head.

    Hank is not his real name but the story chronicles his REAL story, a collegiate football player that had to end his playing career due to a concussion, or multiple concussions.

    Hank said this semester of school has been by far the most difficult; however, he said a lot of the struggles might be because he has been recovering from two concussions most of the time.

    “The hardest (semester) I’ve ever done and I’m taking some of the easiest classes. That’s pretty frustrating,” Hank said.

    During his recovery, Hank said it was hard to concentrate on school as he was having splitting headaches all the time and not getting a lot of sleep. Continue reading

    Struggling with Academics

    In an article published in the Daily Pennsylvanian author Calder Silcox explored the difficulties of returning to the daily grind of an Ivy League football player after his 5th concussion.  Colin Donnelly explains;

    “Doing work was hard,” he said. “I would get headaches when I would focus, when I would read. Class was pretty much the same thing.”

    Colin added that in the weeks after his concussion, he had trouble recalling what he’d just read or heard in class. At the advice of his doctors, he avoided school for an entire week, watching as the work piled up.

    “My short term memory was just foggy until I recovered,” he said.

    Concussion/head trauma recovery is all based upon giving the brain some much-needed rest.  Something as simple as reading, watching TV, or trying to concentrate on auditory stimulation can cause the brain to react negatively.

    The impact of this issue is more prevalent with the youth, those that are still in school, trying to concentrate on work, social life and just being a kid.  Parents, teachers and mentors should be aware of this and seek out people who can help those understand the nature of this beast.

    TCB Question…

    Was thinking during my daily commute (always dangerous) and thought that maybe if I proposed this question on the blog, we could get some great comments/emails.

    Here is the question:

    If there are traumatic forces to the head/neck area can you have a neck injury WITHOUT a brain injury?

    For years (as long as anyone can remember) we as athletic trainers have always been told that if you have a head injury, suspect a neck injury.  It may actually be the other way around, no?

    Comment here or send email to theconcussionblog@comcast.net and I will re-post with/without names…

    Academic Accommodations

    In the most recent Journal of Athletic Training, Neal McGrath was published about the accommodations that may need to be made for concussed students.  This topic is one that is commonly overlooked by those that care for the student-athlete that has a concussion.  The every day tasks of walking in a hallway at a high school can be very difficult.

    Below are the accommodations that were suggested, if you jump to the article you will see the rationale for each.

    • Excused Absence
    • Rest Periods During Day
    • Extension of Assignments
    • Postponement or Staggering of Tests
    • Excuse from Specific Tests
    • Extended Testing Time
    • Accommodations to Sensitivity to Noise/Light
    • Excuse from PE/Sports
    • Avoid other Physical Exertion
    • Use of Reader for Tests/Assignments
    • Use of Note Taker/Scribe
    • Use of Smaller/Quieter Testing Room
    • Preferential Classroom Seating
    • Use of Tutor

     

    Oh Canada

    One would think that with hockey being its national sport and concussions a big part of that sport, Canada would be all aboard the ImPACT system.  It seems some hockey programs were doing just that, but football was overlooked.  An article on London Free Press’s website, reports that Aquinas High School is the first to implement this for football in all of Canada.

    Way to go eh!

    Using Experience to be The Best

    Thomas Bottiglieri made a decision to give up football and pursue his career of choice, medicine, after multiple concussions.  Now living and practicing in Englewood, New Jersey, Bottiglieri has become one of the most respected concussion specialists in the area.

    He was one of those kids who suffered debilitating symptoms but kept them to himself to stay on the field. He hid them until he could no longer play or study.

    Even after quitting football in 1996, he nearly lost the opportunity to become a doctor. His academic struggles were so serious that his adviser suggested that he change his major.

    “I just went into this major funk, depression. And I started flunking classes, which is something I had not experienced in my whole life,” said Bottiglieri, who also serves as team doctor for several North Jersey high schools.

    “I remember the depression being the worst part of it. There was no highs, it was all just very, very low. Not only was my sport taken away, but I had a headache everyday. I couldn’t pass my classes. No one could understand what was happening to me.”

    I can only imagine how hard it was to spell his name after concussions.