The Right Time to put your Head First

by Tori Simonetti, ATC/L
HeadFirst Concussion Care Educator

The most important test a healthy student athlete can take is a baseline ImPACT test.

The baseline test is a computerized neurocognitive assessment of the athlete when he or she is injury-free. We hope an athlete never gets hurt, but if a suspected head injury does occur, the athlete retakes the test. The two results are compared and, together, become a tool in assessing the extent of the athlete’s injury, and when he or she safe to return to playing sports.

concussion_impact_testSince most high schools recognize the dangers posed by concussions and the risk of returning to play too soon, baseline testing is becoming a standard best practice at more schools. The majority of private and public high schools in Maryland are making the baseline ImPACT test mandatory for all student-athletes.

The test is set up in a series of brain games and takes about 30 minutes to complete. It measures your student athlete’s memory, reaction time, brain processing speed and concentration. To ensure your athlete is prepared to take the baseline test be sure he or she:
•  gets a good night rest;
•  takes any medications as he or she is normally prescribed;
•  wears his or her glasses or contacts;
•  take his or her time and reads the instructions thoroughly and carefully; and
•  stays focused, especially when taking the test at school or with the entire team.

Lastly, remember to relax and don’t be nervous! The test is not measuring how smart the athlete is and is not comparing their results to anyone else. It is designed to compare to any subsequent tests they may take in case of an injury.

Spring Injury Prevention Tips

by Daniel Pokrifka, ATC/L
HeadFirst Concussion Care Program Administrator

Basic physics teaches us that an object at rest will always remain at rest unless acted on by an unbalanced force. Likewise, an object in motion will continue in motion with the same speed and in the same direction unless acted upon by an unbalanced force. We humans are objects that seem to always be always in motion, so it stands to reason that we’re continually acted upon by external forces that change our direction. Unfortunately, the direction that these forces sometimes push us coincides with another of Newton’s Laws: Gravity.

ImageSlips and falls are one of the top causes of unintentional injuries in the United States, accounting for approximately 8.9 million visits to the emergency department annually (National Safety Council Injury Facts 2011). When we fall, it always seems like we fall head first. Falling out of bed, slipping in the bath, falling down steps, and falling from ladders accounts for a large percentage of head traumas, some of which can result in Mild Traumatic Brain Injuries (MTBI).

Since becoming an object perpetually at rest is not an option lowering the impact of these unbalanced forces is the only way we can prevent these traumatic injuries from occurring. Fortunately with spring in the air now is a good time clean up our homes (where most of these injuries occur) to prevent these injuries from happening.

Here are some home safety tips to help prevent injuries and falls:

o   Clean up all spills immediately

o   Stay off freshly mopped floors

o   Secure electrical and phone cords out of traffic areas

o   Remove small throw rugs or use non-skid mats to keep them from slipping

o   Keep frequently used items in easily reachable areas

o   Wear shoes with good support and slip-resistant soles

o   Arrange furniture to provide open walking pathways

o   Keep drawers and cabinet doors closed at all times

o   Install handrails on all staircases on both sides

o   Remove tripping hazards (paper, boxes, books, clothes, toys, shoes) from stairs and walkways

o   If you have young children, install gates at the top and bottom of stairs (unlatch the gate in order to pass – don’t climb over them)

o   Ensure adequate lighting both indoors and outdoors

o   Remove debris from exterior walkways

o   Adjust gutter downspouts to drive water away from pathways

o   Periodically check the condition of walkways and steps, and repair damages immediately

o   Never stand on a chair, table or other surface on wheels
(NSC Injury Facts 2011).

These tips are quick and easy to do all it takes is a little effort to prevent you or a loved one from getting hurt.

Happy Spring!

To Play or Not to Play (Football)? It’s the Parents’ Decision

by Daniel Pokrifka, ATC/L
HeadFirst Concussion Care Program Administrator

In my years as an Athletic Trainer, I’ve had the opportunity to interact with many parents, helping them to foster a safe sports environment for their children and to guide a few of them through the road to recover after an injury. During these exchanges I always felt competent in my guidance, and leaning on my research-based medical practices, I provided sound advice. But this past summer I ‘ve added a new perspective to my consultation résumé… I became a Dad.

As I hold my new baby boy, my thoughts go back to these families as I can now empathize with their fears of letting their children leave the safety of mom’s and dad’s arms and expand their world. Watching Alex grow from this tiny baby who I could hold in the palms of my hands into the beginnings of a sturdy little boy, I find myself thinking about one of the most common questions asked of me by parents while sitting in a clinic with their injured son or daughter: “With all the injuries in sports, should I continue to encourage my child to participate in athletics?”

The answer was always an emphatic ‘YES!’ I explained how, in my opinion, the benefits of athletics clearly outweigh the risks of injury and the lessons learned can last long into their future. Inevitably, the follow-up question was always “What about going back to football”? Ah, always a little more challenging of a question… or should it not have been?

Years ago, as an athlete, I would have expressed my opinions emphatically about how football teaches the principles of teamwork, commitment and self-confidence while placing demands on the athlete that are not only physical but require a level of grit determination found only on the gridiron under the Friday night lights. But as a sports medical professional, and now as a parent, would I still provide this same advice to myself if my son decides to play?

I have heard from many new parents who say they would never allow their child to play football because they don’t want them to get a concussion, which is usually followed by “my son or daughter will play soccer because it’s ‘much safer.’” At this point, parents are usually looking for a nod of confirmation.

It seems popular nowadays to listen to all the ‘soft’ studies reported by the media that directly relate concussions and other catastrophic injuries to playing football. In my experience, the hard numbers show that concussions are not solely a football problem. My professional responsibilities inherently place me directly around young injured athletes in many different sports and activities and I have seen concussions in all of them.

Heads Up: Concussion in Football

This is also a good time to mention that most of the concussions I have seen over the past few years did not occur during a sport at all…
…kid got hit in the head with a drum mallet during marching band
…whole family suffered concussions from a motor vehicle accident
…kid said he got hit by a shelf
…sledding accidents, trampoline mishaps… and on the list goes.

We’ll never be able to fully protect our kids from the world, but we CAN demand a higher level of safety from those responsible for our children. We CAN and SHOULD educate ourselves — and our children — about the injuries that can occur during sports and prepare ourselves for if and when they occur. We CAN be truthful on our kid’s sports physicals and go further than the minimum requirements. We CAN inquire about baselines for concussions and pre-participation strength and agility training to prepare our kids for the physical demands of the sport. Injuries cannot be prevented, but the risk can be minimized with preparation.

My profession allows me to be at the forefront of this preparation, to be an advocate for safety, and to educate anyone willing to listen. And I can say that many athletic associations are taking notice of the rise in injury awareness and utilizing their authority to help protect our kids.

My message here in this post is convey to parents that even a dad in the “business”— one that has access to all the data and research — still struggles with the decision on whether I will allow my son to play football.

Now for the toughest part: my answer.

Let’s just say I’m lucky that I have another seven to ten years of research until I have to make this decision, but I will say something inside me is excited to start finding those permission slips in the bottom of his backpack.

Athletic Trainers Treat and Manage Concussions

by Daniel Pokrifka, ATC/L
HeadFirst Concussion Care Program Administrator

Last month was Brain Injury Awareness Month, but did you know it was also Athletic Training Month? However, it’s important to be educated throughout the year about the roles that both play in sports. As a Certified Athletic Trainer (ATC), I’ve taken the past few weeks to reflect on the progress of care for mild traumatic brain injury (MTBI) and how it fits into the development of the athletic training profession.

Both have come a very long way in the time I’ve been involved with them. More importantly, though, is where each is headed in the future. Certainly, the two fields will remain integral to each other. When I was taking undergraduate courses, the instruction given regarding concussion care amounted to little more than a few PowerPoint slides in a single lecture in one class of my sophomore year.

At the time, the guidelines for returning an athlete to play were to wait just 10-15 minutes of being free of symptoms! I remember realizing the signs and symptoms of concussions and counting on both hands the number of concussions I must have sustained during my high school days that were never diagnosed or treated. For most of those injuries, the only thought going through my head was ‘get up before the other guy’ and ‘make sure you go back to the correct sideline!’

While an athlete’s mentality may not have changed much, thankfully medical understanding of MTBI and the care standards have increased dramatically. While we still have a long way to go, I am confident we have at least reached a precautionary stage that will turn the tide, and begin to pay dividends in the long term health quality of today’s athletes and athletes yet to come.

The other major change I have seen is in the field of athletic training. ATCs are recognized and valued in the medical community and general public at a much higher level than in previous years. Often in my career I’ve had to answer questions about what an athletic trainer is and does. Many times, I’ve explained that I’m not a strengthening and conditioning coach, nor a personal trainer, nor a fitness instructor. I’ve also had to explain to medical providers and staff my reasons for, and legality in, obtaining medical information for the continuing care of our patients.

These days, we see physicians volunteering the information to ATCs, and often seeking their opinion and input in the care of an athlete. Many providers, parents, and school administrators rely on Certified Athletic Trainers for creating, instituting, advising and enforcing care plans, policies and procedures, liability issues, and more. The benefits gained for the athlete with this partnership are huge.

ATC Word Cloud

I believe concussion care is headed the same way, and soon, we’ll see tremendous scientific breakthroughs in medical technology which will translate to safer healthy sports. As we gain a better understanding of MTBI and learn the most effective courses in preventing, diagnosing and treating these injuries, the role of an ATC will become more defined. Our role in concussion care will be as important as our role in treating, for example, sprained ankles and dehydration.

As a result, we’ll need to become keener in our decisions about when to treat a concussion and when to manage it. To parallel two common injuries to understanding the difference between treating and managing concussions, a sprained ankle requires an ATC to provide first aid, treatment, and rehabilitation to get the athlete back on the field. They understand the healing process and the necessary intervention.

A sprained anterior cruciate ligament (ACL), however, is a different matter. Although ATC understand all of the necessary interventions, they can’t provide all the treatment an athlete will need. The athletic trainer will refer the athlete to an orthopedic surgeon to order an MRI, conduct surgical intervention, and prescribe any necessary medications. In certain settings, the post-surgical rehabilitation may be better handled by a physical therapist.

While the ATC relies on these providers for the care of their athletes, it is still the ATC that manages the injury by directing the referrals, following up on the athlete’s compliance and resolving any issues that arise in the care plan.

As the seriousness of MTBI has been realized, so has the availability of well-trained medical personal with unique specialties to assist ATCs in the care of concussions. We now have a variety of referral sources to care for athletes including neurologists, neuropsychologists, vestibular therapists and ocular-motor therapists.   With these valuable referral sources, ATCs will always be the direct link and closest manager of the best care available for athletes.