Sometimes dismissed as just “having your bell rung,” a major blow to the head should – in reality – set off alarm bells.
Concussion is increasingly recognized as a serious injury needing treatment. The National Football League has issued warnings about it to players, and Congress has held hearings about its effect in youth sports. California’s governing body for high school athletics recently decreed that anyone with concussion symptoms be removed from the game or practice; return to play requires a physician’s consent.
This summer, UC Irvine doctors evaluated members of the football team at Anaheim’s Servite High School as part of an effort to better diagnose and treat concussion.
Clinical psychologist David Franklin and Servite staff conducted tests in which a computer recorded each player’s comprehension and recall of shapes, words and spatial arrangements. This baseline measurement can be compared to results of tests administered during the season to any team members exhibiting concussion symptoms. If warranted, students will be referred to a doctor.
“In Southern California, there’s no standard of care concerning the cognitive effects of concussion in athletes – some players stay on the field, and some players come off,” says Franklin. “This testing is a screening tool to help coaches, trainers and healthcare professionals determine who needs further treatment.”
The state’s defending football champion, Servite will evaluate all students in contact sports, including basketball, soccer and lacrosse. “Parents expect us to do the right thing to protect their children,” says Servite principal Michael Brennan.
UCI hopes to expand the testing to other area high schools, Franklin says. More than 4,000 student athletes in Orange County sustain concussions each year. UC Irvine Healthcare’s goal is to ensure that they are properly diagnosed and receive the care necessary to minimize damage.
“Most people don’t realize how common concussions are or how serious they can be, especially for kids, whose brains are still developing,” says Dr. David Kruse, a board-certified specialist in sports medicine.
While still being studied, the consequences of repeated concussion include depression, impaired cognition and memory, and slurred speech. There also may be an increased risk of dementia-related diseases like Alzheimer’s and such neuromuscular diseases as ALS.
The baseline testing is one component of UCI’s new Comprehensive Sports Concussion Program, which draws on specialists in sports medicine, neuropsychology, and physical medicine & rehabilitation.
Franklin and Kruse are co-founding directors of the program, along with Dr. Danielle Perret and Dr. Justin Hata of UCI’s Center for Pain Management. The team works with referring physicians to provide medical treatment, pain management, rehabilitation, counseling and other follow-up care.
“People should understand that a concussion is a traumatic brain injury,” says Perret. “Research has shown a cumulative effect – the more concussions you have, the greater the potential long-term injury.”
She believes the California Interscholastic Federation rule against immediate return to play is important. “There’s a great danger in letting someone return to an activity before he or she has fully recovered from a concussion,” says Perret, who co-wrote the chapter on concussion in the standard medical text for sports medicine.
It’s a misconception that concussion only results from a blow to the head, notes Hata: “A player may be hit in the lower body, but the torsional force could be transferred to his head, and the brain might shake inside his skull.” Nor will someone with a concussion necessarily lose consciousness, he adds.
In August, the UCI doctors conducted a symposium for coaches, athletic trainers, school nurses and educators at which they addressed these issues and discussed the latest research and practices related to treating concussion.
“The bottom line is that concussions are no laughing matter,” says Kruse. “Brushing them off as ‘getting your bell rung’ is no longer acceptable.”