In the old days, an athlete shaken up by a play or some other on-field mishap was often told to “suck it up,” or “shake it off,” or “get back there and play,” especially if nothing seemed physically wrong with him. What were seen as minor head injuries were often described as being “rattled” and it was thought that the best way to deal with them was to do a little stretching or work out, then head back onto the field.
All of this changed dramatically a few years ago in New Jersey after a Montclair teen went back on the field after supposedly being “shaken up” – and fell dead a few minutes later after a second “rattling.”
“The second incident doesn’t have to be anything significant,” said Dr. Sean Lager, who was among a handful of dignitaries and hospital officials unveiling a program at Hoboken University Hospital on Monday that will help set up yet another level of protection for young athletes throughout Hudson County from the risks associated with concussions. “Even minor contact can be dangerous after the first incident.”
“Everyone is different,” said Dave Klause from Cleared to Play.Org, Inc., the not-for-profit organization that is developing a data base of student athletes that would give medical and sports officials a clearer picture of what is normal for each athlete. The system would let officials testing the athletes before they are injured and have an image against which to compare if there are questions about the athlete later.
Test available countywide
The program was launched at Union City High School in August, but is expected to blossom with the agreement with Hoboken University Medical Center, Christ Hospital, and Bayonne Medical Center, who have partnered with Cleared to Play.Org to make the pre-testing program more readily available. The hospitals donated $10,000 to the effort and will pay for the testing of 5,000 student athletes throughout Hudson County at the three hospitals.
Dr. Lager, who works with athletes to diagnose and treat injuries, said tests are administered using Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) which is used currently by the NFL. The test is administered pre-season to establish a player’s baseline brain function.
If a concussion is diagnosed, the player retakes the test to determine how he or she has been affected by the injury. The results of the test are then used as part of the criteria for assessing when the player has recovered from the injury and can return to play.
The program is open to all student athletes throughout Hudson County.
“Being able to ensure that athletes are fully recovered from a concussion before returning to their sport is essential for their overall good health and well-being,” said Paul A. Walker, president and chief executive officer of Hoboken University Medical Center.
According to Peter A. Kelly, president and CEO of Christ Hospital, it is crucial to raise awareness about the devastating effects that can arise from continue episodes of concussions on young people.
Lager said while concussion have become a significant issue for professional sports, the impact is even more significant among young athletes whose brains are not yet fully developed and can suffer even more significant damage even from what might be considered minor injuries – especially second episode situation which have been proven to kill.
“Schools in our area either do not have the funding for ImPACT testing or the facilities to administer the tests,” said Dr. Mark Spector, president and CEO of Bayonne Medical Center. “Presently, no major health insurance company in New Jersey will pay for the pre-season base-line test. Our partnership with Cleared to Play.Org, Inc. will help ensure that these important tests are available for students in Hudson County as well as any child in or out of sports activity that may have a concussion.”
“Schools in our area either do not have the funding for ImPACT testing or the facilities to administer the tests.” – Dr. Mark Spector
New procedures and safeguards
A student-athlete who sustains, or is suspected of having sustained, a concussion or head injury, will be removed immediately from a sporting event and will not be permitted to participate in further sports activity until he is evaluated and cleared by a physician or other properly licensed and trained healthcare provider.
Although professional sports teams have put into place more aggressive steps to deal with the threat of concussions, school programs were largely left up to local districts, and were often inconsistent in how coaches dealt with the issue and who was responsible for determining if an athlete was at risk.
Some districts continued variations on the old tried and true evaluation methods, looking for visible signs of a problem, and once dizziness or other signs abated, returned the athlete to the field.
But as the Montclair case proved, sometimes these signs are subtle or missed by coaches untrained to look for them, and sometimes the initial incident put an athlete at risk that mere “shaking off” a spell would not solve.
Everything changed for school athletics in 2010, when Gov. Christopher Christie signed legislation designed to protect student-athletes and prevent concussions on the sports field. The state set up strict criteria for dealing with concussions and their aftermath, requiring the input of health professionals in evaluating the condition of an athlete after a first brush with a possible concussion, and specific steps to keep that athlete from the second and possibly deadly encounter they might face by going back onto the field too soon.
Some of the state requirements include determining the appropriate amount of time a student-athlete must wait before returning to sports competition or practice after sustaining an injury.
But in a medical field that is still coming to grips with this new reality, gaps still exist in this evaluation process. Although kids are tested to see if they have suffered a head injury that could put them at risk, sometimes this is so subtle that tests might prove inconclusive.
Although there are criteria for when to pull a student athlete from the field and when to permit him or her to return after recovery from a concussion, each event must be evaluated on a case by case basis.