[caption id="attachment_16579" align="alignright" width="300" caption="Governor Markell signs SB-111, formalizing Delaware's policies for treating and preventing concussions in scholastic sports. Click the image above to watch highlights of the bill-signing ceremony."]https://www.wdde.org/wp-content/uploads/2011/08/concuss-bill-300x168.jpg[/caption]
Long gone are the days when a high school athlete knocked dizzy during a game was given a whiff of smelling salts or ammonia and sent back into the field.
Nowadays, Delaware’s coaches, trainers, administrators - and even student-athletes themselves - are becoming more aware of the risk of concussions.
It has not always been easy to err on the side of caution as professional sports leagues glorify hard-hitting and sacrificing for the team.
Caleb Lathem, a senior at Christiana High School, is now gearing up for a new soccer season. Last season while playing lacrosse he suffered a concussion during a helmet-to-helmet collision. Caleb missed about two or three weeks of play at the time.
“A lot of headaches, dizziness, and sensitivity to light and sound” is how he describes the effects of the concussion. “I just wanted to go out and play, but I couldn’t.”
That’s because under Delaware Interscholastic Athletic Association (DIAA) rules which have been revised over the past few years, even a suspected concussion is treated with a very cautious set of procedures designed to keep the athlete from returning to competition until medically cleared to play. The goal is to avoid a second or third concussion, which can become more likely after the initial injury.
In 2008, Delaware was one of a handful of states to adopt a restrictive return-to-play policy when an athlete was suspected to have a concussion or had been diagnosed with one, according to DIAA executive director Kevin Charles. The DIAA also adopted policies in 2010 that were based on guidelines from the National Federation of High Schools and apply to the association’s member schools. The revisions included giving on-field officials the discretion to remove a player who may exhibit concussion symptoms.
This year, the Delaware General Assembly approved legislation that formally requires the student-athlete and the athlete’s parent or guardian to sign and return a concussion information sheet each year. Also, coaches will be required to receive training on how to spot possible concussions.
Governor Markell signed the bill into law Tuesday in Dover. Delaware is the 29th state since 2009 and the 22nd this year to enact legislation to formally strengthen how it deals with concussions in scholastic sports according to the National Football League’s (NFL) Senior Vice President of Government Relations and Public Policy Jeff Miller. In May 2010, NFL commissioner Roger Goodell sent letters to 44 states, including Delaware, which did not have concussion laws on the books urging them to create them.
Delaware’s move comes after several years of study and awareness about the effects of blows to the head.
“It’s increased knowledge and awareness in the medical community which has then filtered down through the National Federation of High Schools and the various sports medicine advisory committees in the various states,” Charles said. “Coaches have to understand that this is not a question of someone’s quote-unquote ‘manhood’ or toughness. It’s not a toughness issue. It’s a medical issue.”
To make sure coaches are on the same page, Christiana High School athletic trainer Jeff Ellis says they all meet once a year to rehash the guidelines. “They’re instructed if they notice any symptoms that kind of mimic a concussion, or even something as simple as a headache, they are to remove the athlete from play,” Ellis said. Typically the athlete is sent to his or her family physician for treatment and evaluation, or taken to the hospital in the event of a more serious concussion or unconsciousness.
Ellis makes a point of also meeting with the athletic team members to review concussion symptoms, the risk of a second-impact following an initial concussion, and why it is important “not to hide the symptoms.”
Concussions and Delaware High Schools
DFM News went to Christiana High School to survey how one Delaware school deals with the issue of concussions.
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Dr. Tony Reed, Director of Sports Medicine at Christiana Care Health System, says he has seen more young athletes with concussion symptoms in the past five years compared to the previous five years. He attributes the rising numbers to more awareness among coaches, trainers and young people about concussions – but also believes that with football in particular, the players are getting bigger and hitting harder.
Also, Reed says concussions have occurred in a variety of sports – soccer, ice hockey, field hockey, lacrosse, and even baseball.
“It’s becoming more and more of an issue, both by identification and I think by overall prevalence,” Reed said.
In a suspected case of concussion, Reed evaluates three major areas: memory, whether they’ve had any memory loss or difficulty making a new memory; concentration and ability to focus; and any other symptoms such as headache, vision problems, and difficulty sleeping.
What makes a concussion different from a simple “ding” to the head, as coaches and players used to call it?
Expert Analysis
DFM News talked to one University of Delaware professor about the medical science behind symptoms, diagnosis and treatment of concussions.
Addressing concussions in college sports
DFM News discusses at length how sports medicine professionals handle concussions in the field, with Lori Leary, athletic trainer for Delaware State University and University of Delaware's Dr. Andrew Reisman.
University of Delaware Professor of Kinesiology and Applied Physiology Thomas Kaminski, PhD compares it to shaking a glass of water with ice cubes. He says a concussion occurs when the brain is pushed up against the back, the front or the inside of the skull. “Depending on what part of the brain has been impacted, those are the signs and symptoms you will have,” Kaminski said. “Some people will have symptoms such as vision problems, hearing problems or memory problems depending on what part of the brain has been impacted.”
Other symptoms may include sensitivity to light, nausea, vomiting, or a lack of concentration in school.
An initial concussion also makes the athlete more vulnerable to a second or third concussion, according to Kaminski, who also serves as Director of Athletic Training Education at UD.
“We as health care professionals need to be very adamant in terms of when those athletes can go back to play,” Kaminski said. “We need to make sure that they are healthy enough, that they can undergo the rigors of the specific sport that they’re playing before they go back to competition because we know that they’re at a greater risk for that second or third concussion.”
Or, in the case of Cody Cipalla, a fifth or a sixth concussion.
Cipalla is now the defensive coordinator for the Christiana High School football team. He suffered a series of concussions while playing football in high school in western Pennsylvania and collegiately at the University of Delaware. The repeated injuries ended his playing career.
“Football is a very physical sport. Unfortunately, concussions are a part of the game,” Cipalla said, adding that from the sidelines he closely watches for symptoms in a player such as a headache or dizziness. If a player appears to be having trouble, Cipalla sends them directly to the training staff for evaluation.
Cipalla says his last concussion was the worst one. He saw doctors and a neurologist and returned home, about a seven-hour drive from the UD campus in Newark, to see more doctors. As he learned more about the risks of concussion, Cipalla came to realize that even after recovering from previous concussions, there was no guarantee he would be all right if he suffered one more – or, if he would experience problems well into the future.
“That’s something scary, and something I really had to think about,” Cipalla said. “You’ve got to really step back and take a look at the big picture.”
A Unique Perspective on Concussions
Excerpts of DFM News' interview with Christiana High asst. football coach Cody Cipalla - who had his college football career at the University of Delaware ended by concussions.
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Coaches and players are all learning about the risks of concussion, and are making adjustments. However, the new Christiana High football coach Barry Zehnder says while he does instruct players on how to make a proper “wrap up” tackle, many a times in the heat of competition perfect form may go out the window.
Players may also be motivated by what they see on TV: the hard hits and collisions make the highlight reels.
“When we instruct the proper technique, the kids are kind of looking a little bored,” Zehnder said. “The good-form tackle doesn’t make the highlights of the Ravens – Pittsburgh game.”
It’s also not just football, although the American Academy of Pediatrics says it is the leading cause of concussions in sports among youth ages 5 to 18. Matt Hammond coaches boys’ soccer at Christiana High and girls’ soccer at Newark High. He’s had numerous players suffer concussions in that sport and in his experience has seen more among the female athletes he has coached.
“I think we’ve impressed upon them the seriousness of it,” Hammond said.
Kaminski, who has future trainers among his students at UD, is supportive of several measures in the still-evolving field of concussion research and prevention. He would like to see the message about head injury awareness shared with even younger athletes, such as fourth-or-fifth-graders. Also, Kaminski sees a benefit in baseline testing in which an athlete is given a standardized memory- and focus-based test at the beginning of a season.
“The nice thing about having a baseline in these athletes is that if they do concuss, we have something to fall back on,” Kaminski said. “The hope is that in the recovery process they can come back to at least baseline. That helps the physicians make a determination whether that student-athlete can go back to competition.”
“We set them down in front of the computer and have them take effectively the same test – different questions but the same test, to compare that against how they were at baseline” Reed said. “You have to score to what you were back at your baseline. That’s how we know that those hidden symptoms or that underlying brain dysfunction has gone away.”
Reed, however, estimates there are a dozen or fewer physicians statewide who are fully versed in baseline testing and able to interpret the results effectively.
Ellis, meanwhile, says mandating baseline tests for young athletes may not be realistic at the high school level, given the fiscal challenges facing Delaware school districts.
“Hopefully, it’s in the near future,” Ellis said.