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Published on August 21, 2015

Football season raises awareness of concussion riskFootball season raises awareness of concussion risk

When the American Medical Association recently adopted policies to lower the risk of brain injuries from concussions in youth sports, they were a little late to the game.

The American Medical Society for Sports Medicine and the American Academy of Neurology had all previously recommended the same policy: If a student is symptomatic of concussion, they must be removed from practice and play until cleared by a medical profession trained in treating concussions.

Additionally, all 50 states have created laws to insure the same policy, beginning with Washington State in 2009.

The big push came after the tragic case of Zackary Lystedt in Washington State, said Andrew Judelson, MD, a physiatrist affiliated with Cape Cod Hospital and Falmouth Hospital who specializes in physical medicine and rehabilitation and is the director of the Sports Concussion Clinic at Spaulding Cape Cod.

Zackary was 13 at the time, playing in Pop Warner football, and he injured his head during a play and was put back into the game about 15 minutes later. After the game, he told his father he had an incredible headache, then collapsed on the field.

He was in a coma for the next nine months and while he survived, the incident changed his life forever. As a result, his parents fought hard to create the Zackary Lystedt Law to prevent similar tragedies from happening to other athletes.

“Zack was suffering from what is called second impact syndrome,” Dr. Judelson said. “Second impact syndrome is everybody’s worst nightmare with concussions.”

The syndrome is just what it sounds like: a person with concussion receives a second blow before they are fully recovered from the first. The second injury does not even have to be a hard hit to trigger second impact syndrome.

“It could be minor,” Dr. Judelson said. “But it leads to a biomechanical vascular catastrophe in the head with a rapid amount of swelling. And because we’ve only got so much space in our skull, the swelling and pressure are very dangerous.”

Fortunately, the syndrome is rare, with between 20 to 50 cases in the past decade. But when it happens, there is a 50 percent chance of death and a 100 percent chance of morbidity, which means permanent cellular brain injury.

Any number is too high for Michele Pavlu, athletic trainer at Nauset Regional High School in Eastham. She pays close attention to the athletes in her programs. She says Massachusetts has had the guidelines since 2010.

“It actually helps us that it’s a law because if a parent complains, we’re just doing what the state tells us to do,” she said. “Plus, there is a consistency of care on the Cape as a region that is improving so much. The doctor shopping that other people are doing to get their child cleared really isn’t happening on Cape because our physicians are more aware.”

Even if a student is injured outside of school, the law requires that it be reported to the school. Pavlu said that about 40 percent of the concussions she sees in students are not related to interscholastic sports teams at all. They occur while skateboarding, bike riding, in car accidents, or in falls at home.

One of the difficult things about concussions is that they are invisible and no two look or act alike. A concussion is a form of brain injury that is typically caused by trauma or force. It doesn’t have to be from a blow to the head; whiplash can also cause it.

They tend to be rapid onset and typically resolve on their own. The time frame for how long it takes for them to go away varies incredibly. One person with a mild concussion could feel fine in two weeks; another person with a similar one could take two months to heal.

Doctors treat concussions in three steps. The first is to assess for symptoms such as dizziness, nausea, blurred vision and headaches. By the time patients reach Dr. Judelson, they have already been diagnosed and are ready for the second step: an exam geared towards physical tests.

“We look at balance and coordination,” he said. “We also look at a lot of visual and other ocular eye things. Many kids will have visual and ocular deficits related to their concussion, which will give them dizziness and double vision. It also affects their ability to focus and concentrate.”

The third step is a neurocognitive ImPACT test. It is a series of computerized tests that all athletes at Nauset and other similarly informed local schools do before allowing a student to play a sport.

The data from the tests provides information about verbal memory, visual memory, processing speed and reaction time. With that information in place there is a baseline that can be used if a concussion is suspected.

“We want to keep them on the fields, but we want to keep them on the fields healthy,” Pavlu said. “That’s our goal, to essentially keep them playing the sport that they love and hopefully they stay healthy doing it.”