Solving concussion problem starts with better detection


November 02, 2007|By MILTON KENT

If you're a parent of a high school athlete, you had to be disturbed by the article in Wednesday's Sun about Maryland quarterback Jordan Steffy's history of concussions, even if you're not a Terps alumnus or fan.

Indeed, the most alarming part of Heather A. Dinich's story was not that Steffy had had two concussions while at Maryland - or at least two that he would admit to - but that he had suffered two concussions while in high school in Pennsylvania.

The high school experiences of Steffy, who has been cleared to play, probably are not unusual. The fact is there are likely thousands of kids across the country, and more than a few in Maryland, who are playing sports at the high school and youth-league levels while suffering the undetected effects of trauma to the brain.

That those injuries aren't being spotted usually isn't the fault of uncaring parents, or of coaches out to test the mettle of kids, or even of foolhardy kids themselves.

We simply don't know enough about the intricacies of the brain or how to spot concussions to be able to always recognize them. Symptoms that could be associated with brain trauma could just as easily be chalked up to forgetfulness or headaches or the like, but with far more dangerous repercussions.

"You can't see concussions. You can see broken limbs," said Gerry Gioia, director of the Safe Concussion Outcome Recovery and Education program at Children's Hospital in Washington.

"The biggest problem is knowledge of what the injury is and recognizing it when it happens. That's the proverbial Grand Canyon that we have to build a bridge over."

Technological advances are making it increasingly easier to test and then treat concussions, from football helmets that measure head movement to software programs that compare a preseason baseline of a kid's performance in a battery of exams to the results after an injury.

There are old-school methods of examining whether an athlete has a concussion, including comparing results of written cognitive tests administered before a season with those after an injury. Some athletic trainers carry pocket-sized cards with questions to ask players after they've been hurt.

Those things are all well and good at the ground level, but the issue could use some study and regulation from those who run the games.

For instance, along with the physical examination required of all athletes before they can play, the state Board of Education should insist on some base-level neurological testing, especially for contact sports such as football, soccer and lacrosse.

In addition, state educational officials should make it mandatory that anyone in a Maryland Public Secondary Schools Athletic Association-sanctioned sport who suffers a head injury and has to leave a game must be seen and cleared by a medical professional before returning to practice or playing again.

Of course, not all of this can be settled at the governmental level. Coaches and parents have to do their parts to watch for signs of irregularities in kids after they've been hurt, an admittedly difficult task, but one that is necessary.

And the kids themselves have to be encouraged to be honest about all their ailments, not just the ones that can be seen. Not every athlete is fortunate enough to be like Steffy and play at a school where a trained medical staff can catch every ailment. Sometimes, the best doctor can be the patient himself, and kids have to be shown the benefits of self-reporting.

"We still have trouble with athletes trying to withhold information because they think we won't let them play," said Andrew Tucker, director of sports medicine at Union Memorial Hospital and the Ravens' head team physician.

"Then, it can be a much tougher and dicier situation in terms of figuring out [whether] these symptoms are due to a blow to the head and therefore a concussion, or are they due to something else? It can be a real challenge."

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