Concussion-Prevention Efforts Zero in on School Sports

The number of sports-related concussions reported by young athletes is on the rise, prompting awareness campaigns from athletic and medical groups, as well as proposed federal legislation to set minimum standards for concussion management in public schools.

Concussions are caused by a jolt to the body or a blow to the head that causes the head to move rapidly back and forth. Concussion symptoms include dizziness, nausea, confusion, slurred speech and memory problems.

Estimates of brain injuries suffered by people of all ages during sports activities range from 1.6 million to 3.8 million a year. Further studies on high school football players specifically range from 43,200 to 67,200 annually.

The National Athletic Trainers’ Association and the National Academy of Neuropsychology Foundation this month launched a campaign to educate athletes, coaches, teachers and parents about concussion. Their efforts coincide with a plan today for the House Education and Labor Committee to introduce legislation that would create guidelines intended to prevent concussions and create a standardized response plan for treating them when they occur. Reps. George Miller, D-Calif., and Timothy H. Bishop, D-N.Y., are the cosponsors.

These moves come in the wake of several recent events that have put concussions in the news.

First, in April, a 21-year-old Pennsylvania State University athlete who committed suicide was found to have had early signs of a brain disorder seen in professional football players who have suffered repeated brain injuries.

Then, in May, the U.S. Government Accountability Office, the investigative arm of the Congress, released a report on concussion in high school sports that said there was no mechanism to track an overall estimate of occurrence, but that the injuries may be underreported because athletes don’t want to be removed from games.

Four months later, a study published in the September issue of the medical journal Pediatrics noted that visits to the emergency room for concussions for children ages 8 to 19 had doubled from 1997 to 2007. This increase came despite an overall decline in participation in organized team sports, the study noted. The American Academy of Pediatrics also released an updated guide to doctors treating youth concussions.

And, before the House education committee made its move, Rep. William J. “Bill” Pascrell, D-N.J., introduced the Concussion Treatment and Care Tools Act of 2009, which would direct the U.S. Department of Health and Human Services to establish concussion-management guidelines and pay for computerized preseason baseline and post-injury neuropsychological testing for student athletes. That bill has been referred to the Health subcommittee of the House Committee on Energy and Commerce.

‘Macho’ Mentality

Experts believe at least some of the increase in concussion diagnoses may be due to greater awareness of the problem. Coaches and athletes are less likely to dismiss a head injury as something to “shake off.”

But then there are well-publicized situations where the monitoring system appears to break down. In the Philadelphia Eagles’ season opener earlier this month, linebacker Stewart Bradley stumbled and fell to the ground after sustaining a hard hit to the head after a play. Quarterback Kevin Kolb also suffered a concussion. Both briefly returned to the game.

“Football is such a macho sport. There’s a pervasive mentality in that sport” to ignore injuries, said Mike Carroll, the head athletic trainer at the 1,000-student Stephenville High School in Stephenville, Texas. “I really have to emphasize that this is not something you can walk off.”

Mr. Carroll, who has been at his school for 20 years, doesn’t have to fight too hard with the coaches when it comes to holding students out who have received concussions. But some students are still slow to report their injuries. Recently, one student who was injured in a Thursday night game didn’t report the problem to the athletic trainer until Friday morning when his father noticed troubling symptoms.

“As the athletic trainer, I can’t be everywhere. It’s important that everyone in the circle [around the athlete] be aware of these injuries and what they can mean,” Mr. Carroll said.

The riskiest sport for concussion is football, according to the Pediatrics report. However, soccer, lacrosse, ice hockey and cheerleading are also sports where participants face a concussion risk. In some sports, such as ice hockey, female athletes report a higher concussion rate than their male counterparts. Experts suggest that may be due a combination of physiological differences that make women more prone to concussion injuries, and female athletes being more willing to admit to injury.

Steven P. Broglio, an assistant professor of kinesiology and community health at the University of Illinois at Urbana-Champaign, has studied head impacts during high school football. He noted that the force of impacts at the high school level exceed those at the collegiate level. One hypothesis, he said, is that high school athletes may not have yet developed the musculature that can prevent sharp head movements. Another possible explanation is that there is a larger size disparity among young athletes.

“And, worse yet, you have the worst medical care at that level,” he added. College athletes and professional athletics have medical staff at practices and games. Those personnel may not be present at the high school level.

He supports having athletic trainers both at games and practices. “The injury rates are a lot higher in games. Kids hit harder,” Mr. Broglio said, “but you practice a lot more than you have games.”

And, once a child has a concussion, administrators and teachers have to be aware that transitioning back into school can be difficult, said Ruben J. Echemendia, a neuropsychologist in State College, Pa., who is chairman of the concussion-management groups for the National Hockey League and Major League Soccer. Mr. Echemendia sees high school athletes as well in his private practice.

“They feel lousy,” Mr. Echemendia said. “Their workload has to be adjusted. A lot of administrators don’t get that, they think they’re trying to milk it or play up the symptoms. But the student actually has a disincentive to exaggerate, because they know they’re not going to play.”