SECOND IMPACT SYNDROME: Sports Confront Consequences of Concussions

USA Today (Society for the Advancement of Education), May, 2000 by Jeffrey H. Tyler, Michael E. Nelson

Sensitive to the invisible symptoms of concussions, the NHL is taking precautions to help prevent them. LaFontaine and Philadelphia Flyers center Eric Lindros, whose brother Brett was forced to retire from the New York Islanders following repeated concussions, contributed to the development of shock-absorbing mouth guards and more-protective helmet designs to reduce susceptibility to concussions. Today, more players are voluntarily wearing mouth guards to decrease their risks. (Meanwhile, Eric Lindros' career is threatened by a series of concussions.)

In addition, the league's Board of Governors in 1999 ordered that all NHL arenas using seamless glass technology be fitted with a board system called CheckFlex, which provides more "give" on contact and could reduce concussions. Despite this step, some rinks still have not installed it.

The NFL has also lost its share of players to multiple concussions and is reacting. NFL Charities has funded a program at Thomas Jefferson University Hospital in Philadelphia to study Philadelphia Eagles players who sustain concussions during game actions. Researchers hope to examine eight players during the next two years.

"Ultimately, we want to use data from our study to construct a clinical examination that can be used right when a player comes to the sideline with a concussion during an actual game," indicates John McShane, team physician for the Eagles and director of primary care sports medicine at the hospital.

As part of the study, when someone sustains a concussion, he will first undergo magnetic resonance spectroscopy, which looks at brain metabolism and detects chemical markers that trace physical changes in the brain. Next, researchers will test coordination, reasoning, and concentration skills. The players will continue to undergo exams until the results return to normal. By correlating test results, researchers can determine when the ill effects of a concussion have disappeared.

The key to reducing an athlete's risk is for players, coaches, trainers, and parents to know the symptoms of concussion and how to manage them. The pro leagues have immense resources and team physicians to assess the symptoms on the sidelines. Many suburban high schools keep certified athletic trainers on site for games, and a number have doctors on the sidelines. Yet, a safety gap remains in many school systems and recreational leagues, where only a coach and players may be on hand during practices and games.

The American Academy of Neurology and the National Brain Injury Association offer the following guidelines for operating a high school or youth sports program focused on safe, proper brain injury management:

* Adequate education for coaches, including sufficient knowledge of head injuries and symptom management.

* Clearly defined standards regarding when and why to refer athletes to physicians.

* A comprehensive system for athletic health care, including these elements: a team physician; athletic trainers; formal education in sports medicine for coaches; informed consent by parents and athletes regarding risks of head injuries; head injury information sheets for parents; requiring that a player with a head injury visit a doctor and receive a return-to-play note; and developing clearly defined and appropriate criteria for returning to play after head injuries.