Concussions have stirred an ongoing debate in the National Football League, where 228 of these head injuries were diagnosed in regular and preseason games during 2013.
The same discussions – how to prevent these injuries and recognize and treat them when they occur – are happening locally, at Nevada Joint Union and other high schools.
Last year 76 diagnosed concussions were recorded at Nevada Joint Union High School (NJUHS) alone, according to Karen Harris, RN, school nurse. Not all of these were caused by football, she said.
“We actually have more concussions that occur outside of sports than we do in sports,” she said. “Adolescents by nature are very active and risk takers. Students often receive their head injury at home and come to the nurse’s office the next day with symptoms. Soccer and cheerleading also usually have a greater number of concussions than other sports.”
Recognizing the symptoms is the key to preventing serious or long-term consequences, Harris said. That’s why she has put such a focus on educating coaches, teachers, and even parents, about spotting symptoms and getting help.
“As a school we are focusing on education to increase awareness and early detection of injuries, and thus increasing the safety of our programs,” she explained. “We send information home in sports packet every year describing concussion symptoms and the importance of prompt follow up if a concussion is suspected. We are also creating athlete and parent education nights.”
Dr. Joel Richnak of Mountain View Rehabilitation in Grass Valley added his own emphasis on the importance of education.
“There have been many long time misunderstandings regarding this injury,” he explained, “including the belief that one had to get knocked out in order to be diagnosed with a concussion. This is simply not true; concussions symptoms are frequently very subtle.”
The good news, he said, is that most athletes can recover completely in a short period of time if their injuries are diagnosed and managed properly.
“The risk lies in not diagnosing the concussion, and allowing the player to return to the game before the first injury heals; if they suffer another blow to the head during this recovery period the injury could be much worse and have much more significant and long-term consequences,” Dr. Richnak cautioned.
In response to new state law governing concussion injuries, and increased media attention, Harris has prepared training for high school coaches and select staff that includes how to spot suspected head injuries, and a step-by-step protocol of actions to take. A Head Injury Evaluation form is given to parents and the student’s physician, and the paperwork goes back to the school nurse for follow up. The school nurse will also monitor recovery through daily symptom checks, and stay in communication with parents and others during the process.
“The standard treatment is cognitive and physical rest,” she said. “This may require no school attendance for a few days and then modified assignments with no test taking when they return. No physical activity is allowed until the student is free of symptoms for two consecutive days.”
Harris said increasing awareness of concussive injuries has encouraged parents to become involved.
“Parents are much more cooperative with the head injury recovery process now than they were a few years ago,” she said. “In the past some parents referred to a concussion by the adage, ‘he got his bell rung.’ The media attention has definitely increased awareness at the high school level.”
Most concussions will heal with appropriate physical and mental rest, Dr. Richnak observed.
When normal healing doesn’t occur, he and his colleagues at Mountain View Rehabilitation, and other specialists in the community, may be called in.
“If a concussion is not healing in an appropriate time frame, or if it is potentially a more complicated case, then we offer cognitive testing which can help with diagnosis, treatment and management decisions,” Dr. Richnak noted.
Treatment may include various types of therapy.
“Because injuries can impair the brain’s ability to process incoming information and cause difficulty with language skills, memory and problem solving, it is important to address all symptoms. Most often, this means working with occupational, physical and speech therapists together in order to heal properly,” shared Laura Fornecker, PT, Rehab Supervisor at Sierra Nevada Memorial Hospital Neurological Rehabilitation, where all of these services are provided.
Dr. Richnak praised Harris for her efforts at educating the high school community about concussion injuries.
“Karen has done an excellent job at NU,” he said.
But education is vital for parents, too.
“The most important recommendation I can make to parents is to educate yourself on what the symptoms of a concussion are, and to make sure that not only their son or daughter are educated, but also the coach and athletic directors at your schools as well,” Dr. Richnak said. “The more eyes that are looking for symptoms, the increased likelihood that the concussion is detected and the right management decisions are made.”
He said free apps are available on the web that might help parents educate themselves. He also suggested that parents might visit the Heads Up program through the Centers for Disease Control to learn more about this problem.
All physicians providing care for patients at SNMH are members of the medical staff and are independent practitioners, not employees of the hospital.