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Sunday, December 29, 2013 - 8:00pm

Concussion Controversy: Return To Play May Be Just The Beginning

Starting January 1, 2014 student athletes will be better protected in gyms and on playing fields across Georgia. At least, that is the goal behind the Return to Play Act.

The new state law requires schools give student athletes and their parents information about concussions. It also mandates that coaches pull a child from activity if he or she shows concussion symptoms.

“We’ve already been doing that, which I think most schools probably have,” said Jeff Hopp, a certified athletic trainer, or ATC, at Marietta High School. “So, for most schools and certainly for us here at Marietta, it won’t change anything in our day to day operations. Literally the only thing that changes is that each coach, when they get their team, they’ll have to get the concussion form signed off on by the parents.”

That concussion awareness form, drafted by the Georgia High School Association, outlines the dangers and symptoms of concussions.

“Concussions at all levels of sports have received a great deal of attention and a state law has been passed to address this issue,” the form reads. “Continued participation in any sport following a concussion can lead to worsening concussion symptoms, as well as increased risk for further injury to the brain, and even death.”

To help avoid worsening the injury, the law specifies that medical professionals including licensed doctors, nurse practitioners, physician assistants and ATCs are the only ones who can decide when a child is ready to return to sports.

Hopp said most health professionals make that determination based on physical exams and symptoms reported by the athletes themselves. But for the last four years Marietta High has also been using a program called ImPACT to determine whether a student’s brain is back to normal.

“It gives us data to look at that we can—hard, concrete numbers,” explained Hopp. “You’ll get some kids that truly have no symptoms and are feeling absolutely fine, but their brain isn’t functioning normally and we can pick that up with the neurocognitive testing.”

ImPACT is just one brand of several brands of computer-based neurocognitive testing on the market. It tests someone’s reaction time and memory using a series of modules that include recalling words, shapes, numbers and colors.

Hopp generally requires all his contact-sport athletes, including football, soccer, basketball, wrestling and cheerleading, to take what’s called a “baseline” ImPACT test during their freshman and junior years of high school. The baseline gives Hopp a score breakdown that he can later use to measure a student’s recovery after a head injury.

“It’s a tool in the toolbox. You know, there [are] a number of things that we do. But it is not the only thing that we will use to determine if an athlete has a concussion or if they’ve recovered from a concussion,” explained Hopp.

The testing is relatively affordable. Marietta High pays $750 per year to use the ImPACT program, according to Hopp.

ImPACTing Future Laws

As researchers try to learn more about the long-term effects of brain injuries, measurable data can prove critical.

“Right now I’m working on a concussion study but I’m focusing more on the middle and secondary school aged children,” said Shelly Linens, an associate professor at Georgia State University. “Research has focused primarily on college age and professional athletes and so we’re trying to look at more the developing brain.”

Linens has been using the ImPACT program to track the brain function of football and soccer players in 19 metro-Atlanta schools. She and her team have tested those athletes before and after their seasons to look for any sign of damage due to ongoing collisions on the playing field.

“We’re looking at subconcussive impacts. So even those kids who don’t necessarily suffer a full blown concussion, they’re still getting head impacts,” Linens explained. “So are those adding up over an entire season to showing results on a neurocognitive tests such as IMPACT?”

The research is also examining whether some children are more susceptible to concussions than others based on height, weight, age or race.

“Is it a rule change? Is it awareness? Is it an age requirement? Is there a weight limit? You know, what kind of restrictions maybe need to come into play? Do we need to be more careful with certain athletes versus others because of susceptibility? We don’t know. So, maybe we can come up with that,” added Linens.

The project is still in the data collection phase, but Linens said she hopes to begin analyzing the information in the summer. She will present any findings to medical conferences and journals, which could impact future concussion legislation or rule changes.

Using Your Head

“There is no way to eliminate concussions,” said Jeff Hopp from the other side of his desk at Marietta High School. “A lot of people look for a quick fix. They want the helmet that’s going to keep their kid from getting a concussion. They want the right mouthpiece or the right technique. There is no way to eliminate concussions.”

Instead, Hopp explained, as both a trainer and Chair of the Georgia Concussion Coalition, his focus has become educating parents, coaches and even doctors about how to recognize and treat brain injuries. Depending on the athlete, the symptoms and the severity can vary widely.

“That’s the one conversation I always have with parents,” Hopp said. “We can look at a knee injury and say, ‘look, it’s going to take two to four weeks for it to get better.’ Unfortunately, with concussions, it’s athlete by athlete. We don’t know.”

There are still a lot of unknowns about concussions, but until researchers learn more, doctors, parents and trainers must carefully consider the impact when athletes return to play.

Here's a copy of the Georgia High School Association concussion awareness form:

House Bill 284: The "Return to Play Act"

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