Concussions Up at High School

Nick Krantz is gang tackled by the University defense.  Krantz leads the squad in rushing this season averaging 7.4 yards per carry.
Nick Krantz is gang tackled by the University defense. Krantz leads the squad in rushing this season averaging 7.4 yards per carry.

By Rita Robinson | LB Indy

In the first eight weeks of the school year, 12 Laguna Beach High School students have been diagnosed with concussions, as many as suffered the injury for the entire 2013-14 session, according to a report presented to the Laguna Beach school board Tuesday.

Football players accounted for 11 of those traumatic brain injuries (tbi) and one soccer player completed the dozen. Two more athletes, a soccer player and a volleyball player, suffered concussions while playing at a private sports club, bringing the total to 14.

Irene White, director of special education and student services, and Mike Churchill, athletic director at Laguna Beach High School, presented the report on the school district’s concussion management guidelines. The protocols meet the legal requirements for reporting and diagnosing concussions that become effective on Jan. 1. A change to the state education code requiring concussion management was made into law in 2011. “We’re getting a lot more direction,” said White.

School staff members are becoming more aware of the signs and symptoms, Churchill explained, and are more likely to ask students demonstrating uncharacteristic behaviors about recent injuries.

In a town where intense outside-school activities range from downhill skateboarding and mountain biking to surfing and body-surfing, concussions can happen. Up to 3.8 million people nationwide sustain a brain injury annually, but most are considered mild, the report says. Symptoms include atypical headaches, disturbed sleep, confusion, distraction and difficulty concentrating. If indicated, the student then tests for head injury.

The prevalence of liability lawsuits in California plays a big role in meeting state requirements, Churchill said.

The district’s guidelines list the procedures for dealing with concussions students incur in and out of school. Before each sport’s season begins, each student athlete is now asked to take a test for cognitive abilities, establishing a personal baseline, Churchill said. So far this year, 700 of 998 students enrolled at the high school have provided a baseline, a protocol established by the district. When a concussion is suspected, the student is given the same test again and results are compared to the student’s baseline.

If the student tests lower in cognitive ability, he or she is directed to see a health-care practitioner specifically trained in concussions, per the new law, for diagnosis. The student can only return to sports activity when the physician gives permission. “A lot of athletes won’t say anything because they don’t want to be taken out of the game,” Churchill told board members.

If the student is diagnosed, the new law requires seven days of “brain rest” without athletic activity or any physical or mental overexertion. Brain rest, explained White, means no cognitive activity, including video games. “I’m a parent; you’ve got to set those limits,” she said. The student athlete will agree, she said, once they understand the importance of rest if they want to play again.

Allowing the brain completely heal from a jarring impact is crucial, says a 2009 article released by the National Institutes of Health. Now known as Second-Impact Syndrome, a secondary impact can cause permanent brain damage and even death. “While rare, it is devastating in that young, healthy patients may die within a few minutes,” Tareg Bey, M.D., and Brian Ostick, M.D., stated in the article. “Emergency physicians should be aware of this syndrome and counsel patients and their parents concerning when to allow an athlete to return to play.”

The rest time fosters the return of concentration, learning ability and memory. “If you stop and think about it, it’s common sense,” said Churchill. “If you sprain your ankle, you stay off of it. If you sprain your brain, get off it and rest. We don’t think about the brain because we don’t see it.”

One of the problems in spotting concussion is that the student may look fine and engage normally with others because the symptoms are subtle, said White. A handbook for parents on concussion resulted from questions asked by a parent last year about symptoms and what to do next, she said.

The new law limits the amount of time a student can participate in full-body contact during practices, like tackling practice at game speed, defines concussion and describes when a student is able to return to the playing field. There’s no limit for full-body contact during a game, White said.

“If the athlete bobbles off the field, we check for concussion,” said Churchill. “It’s like a field sobriety test. We check balance; they follow the finger. If they can’t do that, they can’t go back on the field.” Two full-body contact practices are allowed each week, not to exceed 90 minutes in a day, according to the new rules.

The new law requires the school, the athletic director, athletic trainers and coaches to inform parents if a concussion is suspected. The district has been working on meeting the state’s requirements for the past 2½ years, White said.

The district is using an outside consultant for baseline testing until the staff is fully trained, White reported. “Quite honestly,” she said, “most M.D.s don’t have a mechanism for post-concussion testing.”

White described the process as a “living document” in that it can change according to the circumstances. “It’s not until you live through it that can you see what’s wrong with it, and we’ll tweak it from there,” she said. If it hadn’t been for testing against a baseline, Churchill said concussions in the soccer and volleyball club players would have gone undetected.

School parent Sheri Morgan suggested to board members that the information to parents about concussion detection and protocols for treatment be made available through the district’s website, adding that one of her children got rear-ended in the canyon, a common concussion-producing accident.

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