Heightened awareness of sports-related concussions and a growing concern of the long-term effects of the injury have recently come to the forefront. This injury is seen at all levels of participation from youth leagues to high schools to colleges and in the professional ranks.
More recently, our state and federal governments have heard the concerns, and the Pennsylvania General Assembly passed Act 101, also known as the Safety in Youth Sports Act. This legislation will require education of parents, coaches and athletes; immediate removal from play if a concussion is suspected; and a player cannot return to play without written clearance by a health care professional specifically trained in the evaluation and management of concussion.
This legislative trend extends across the country as numerous states are passing similar bills and national agencies such as the Centers for Disease Control and Prevention are also creating protocols in an effort to protect athletes.
The CDC estimates 1.6 to 3.8 million sports-related concussions occur annually. Concussions were not originally considered potentially serious injuries but we now know that they can lead to long-term difficulties in thinking and, in rare cases, even death.
A comprehensive approach to evaluating concussions includes neuropsychological testing, which is useful in identifying cognitive problems that often linger after physical symptoms have resolved.
One of the more commonly used neurocognitive tests, ImPACT, is used throughout Centre County middle and high schools. The transition back into the school environment after a concussion can be difficult for young athletes and must be handled through a coordinated effort among the school, medical personnel and parents.
Students, parents and coaches must understand the signs and symptoms of concussion to prevent the serious consequences that can occur if an athlete continues to play with symptoms. Return to play should follow a series of steps starting with symptom resolution at rest, resolution of cognitive symptoms, gradual physical exertion and return to neurocognitive baseline.
One might ask what is being done to protect our athletes. Four local school districts have had the question answered in the formation of the Central Pennsylvania Concussion Care Cooperative this fall.
CPCCC is a joint effort between Psychological and Neurobehavioral Associates Inc. and University Orthopedics Center. The mission of CPCCC is twofold to provide state-of-the-art concussion-care management and high-quality educational programs for our community.
A concussion treatment and management protocol was developed by the CPCCC with input by UOC Sports Medicine physicians and certified athletic training staff and neuropsychologist Dr. Ruben Echemendia. The program was implemented at Bellefonte, Penns Valley, State College and Mifflin County school districts in August.
Understanding the signs and symptoms of the injury and how it uniquely affects the adolescent population allowed for the customization of an injury-management system that considers the unique aspects of the developing brain, including a greater number of symptoms, longer healing times and greater susceptibility to subsequent injury.
Taken together, an understanding of these factors and research evidence enabled the CPCCC to apply evidence-based return-to-play standards with central Pennsylvania youth.
CPCCC feels that safety in youth sports and the quality care provided begin with a thorough understanding of concussive injury, the injuries effects on adolescent athletes and a comprehensive injury-management program.
Alison Krajewski is an athletic trainer with University Orthopedics. Jackie Stanley, Ellyn Gildea and Thomas Newman contributed to this article.