BY JENNA HUTCHINS
Dominican College hosted its Third Annual Healthcare Symposium last Monday night featuring specialists in the field of concussion.
Doctors from NYU Langone Medical Center (NYULMC) and other panelists presented on the latest research on concussion and gave the audience tips on how to identify it and administer treatment. Dr. N. Noel Testa, consultant for the Public Schools Athletic League (PSAL) introduced panelists and keynote speaker, Dr. Dennis Cardone, who is the chief medical officer for the PSAL and an associate professor at NYU Langone Medical Center.
Dr. Cardone said that one in every 10 sports injuries are concussion, or mild traumatic brain injury. Concussion can occur without a direct hit to the head. Any direct blow or impulsive force on the body, such as to the chest, back, or legs can cause concussion.
He said that when making a decision about an athlete, most cases do not require the emergency room. Concussion involves functional disturbances, not structural ones. CT Scans, MRIs, and X-Rays are almost always unnecessary and negative, and do not help in the diagnosis of concussion. It’s important for parents and coaches to keep this in mind, as well as the classic symptoms of concussion, such as headache, memory loss, dizziness, balance problems, and delayed verbal and motor responses. Less than 10 percent of all concussions have a loss of consciousness, so this is not a good way to judge a concussion, or its degree.
There are red flags that indicate if an athlete should go to the emergency room. These include worsening symptoms, seizures, looking drowsy and difficulty waking up, repeated vomiting, severe headache, and slurred speech. As long as symptoms do not worsen, physical and cognitive rest is recommended for athletes with concussion.
Dr. Prin Amorapanth, a clinical instructor and researcher at NYULMC, said that the scientific community is split over how long an athlete suffering from concussion should rest. He said that rest is important early on in recovery, and pointed out that sleep is not the only type of rest. In fact, over-sleeping may disrupt the sleep cycle and delay recovery. Research has shown that light aerobic exercise can be beneficial during recovery and a graded return to play is necessary by increasing daily activities slowly.
Mara Sproul, registered nurse and program coordinator at NYULMC spoke about the importance of return to learn before return to play.
Return to learn for student athletes is individualized and never the same day as when the injury occurred. Complete cognitive rest is necessary, and the return to school should be gradual. Sproul recommends one to two hours of homework when a student can tolerate a half-day of school, and three to four hours of homework if he or she can tolerate a full day. The sooner a student can return to school, the better, because added anxiety from missing work hurts recovery.
Teachers should have lines of communication open with parents and athletic teams and work with students on assignments. Extended time may be needed for assignments and alternate work should be given instead of piling on missed work. Testing should also be avoided until the student can tolerate a full day of school.
Teachers are also important in recognizing changes or difficulty in processing, concentration, speech, reasoning and problem solving, and reaction time. Teachers should communicate this with parents and coaches and offer support to students when possible.
The director of Athletic Training at Dominican College reminded parents and coaches that helmets and protective equipment are not perfect. Jim Crawley said the best helmets have a lot of padding, are fitted properly, and are relatively new and haven’t been reconditioned. There will always be a risk of head injury in sports, but researching the best helmets and getting them for athletes can help reduce the risk.
Dr. John Gallucci, medical coordinator for Major League Soccer, urged audience members to go back to their communities and give an hour-long presentation on the signs and symptoms of athletes and individuals with concussion. It could potentially prevent loss of life to educate communities on concussion and also on second impact syndrome.
According to Dr. Cardone, second impact syndrome occurs when an athlete sustains a concussion and returns to play before they are fully recovered. Athletes under the age of 19 are at a greater risk for this, and 3-5 athletes die from this each year in the country. Even if a physician clears an athlete for play, coaches and parents who know the athlete better than the physician have the final say on when to return.
The Executive Director of the Public Schools Athletic League, Donald Douglas, said that with over 40,000 students participating in the PSAL, which oversees competitions for all New York City Public High Schools, it is the safest athletic program in the country. All coaches are trained and certified to identify concussion and no game can take place without a doctor present. He said it is important to stay at the forefront in safety and be a model for the country to see what NYC is doing.
Additional information on concussion for parents and coaches can be found on the NYU Langone Medical Center’s website: NYULMC.org/concussion.