Much of the recent media coverage on concussions in football has been focused on professional athletes.
But young athletes, particularly those still in middle and high school, may be more concerning. Young brains are still developing and may be more susceptible to the effects of concussion.
Football gets all the attention in the concussion crisis debate, and perhaps with good reason. That sport is where much of the solid data come from. But soccer, lacrosse, basketball, wrestling, softball, volley ball and cheerleading are just a few of other sports known to cause concussion. In fact, the rate of concussion may be underestimated in these sports because parents, coaches and the kids themselves aren’t as likely to anticipate this kind of injury.
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Fortunately, in California, all school coaches must receive training in how to deal with concussions. But it’s not enough to train coaches. Although the law doesn’t go this far, it makes sense for physical education teachers, lunch recess monitors and others at school to also be as familiar with signs of concussion after an injury. Parents of athletes should know that sometimes symptoms don’t present until hours after the injury occurred. For that reason, school nurses should let parents know when a student appears to have had a blow to the head, even if the student seemed fine afterward.
Schools’ responsibility goes beyond identification of likely and possible concussions. Student athletes should be informed as well, and adherence to donning safety gear and safe practices is a major part of prevention. Some schools are baseline testing all their athletes before practice or play to note their skill levels in attention, memory and balance.
The idea is that if a head injury occurs, it will be easier to measure severity. These practices have not yet been conclusively proven to be worth the expense, or even worthwhile at all. Nevertheless, a cottage industry has sprung up to provide schools with these. The same is true of “smart” helmets that detect concussions. While I am inclined to regard the promotion of such products to cash-strapped schools and parents as sheer profiteering, if one or two creative ideas is properly and independently researched and found to be effective, I’ll be thankful for the creativity.
Doctors, parents and school staff share responsibility in managing concussions afterward. We don’t yet know whether youth should receive short or long periods of cognitive rest (i.e., no learning, driving, reading, texting, video gaming or even watching TV). Neurologists and neuro-researchers are still working all that out.
Regardless, when a student does return to school after a concussion, his or her memory, attention span and even mood may be mildly to severely impaired. They may still get blurry vision or headaches or experience sensitivity to light or noise. There is no “classic” concussion in terms of type and duration of symptoms – they are very different. And stimulation in a busy high school may bring out brain problems that didn’t surface when these kids were observed at home, in a doctor’s office or otherwise quiet area.
Teachers and staff need to be aware of all this. They’ll need to expect less from recovering students and make educational adjustments. School psychologists and speech language therapists, who normally work with students enrolled in special education, may need to get involved. Communication between a representative of the school staff and students’ physicians and parents is critical, so that all are on the same page.
When symptoms at school extend beyond three weeks, it’s worthwhile to consider formalized accommodation plans (often called “504 Plans” as they are mandated under Section 504 of the federal Rehabilitation Act). In rare cases where symptoms persist for months, it’s appropriate for a student to be assessed for additional services provided by special education, so that a fuller range of resources can be made available to support that youth’s different way of learning.
From before the blow happens to months afterward, it takes a village to address concussions. But for the safety of our players at their most vulnerable age, I’d wager it’s more than worth the effort.
Howard Taras is a pediatrician and a professor at UCSD. Taras’ commentary has been edited for style and clarity. See anything in there we should fact check? Tell us what to check out here.