Sunday, February 12, 2012

Concussion Care Protocol Takes Injury Seriously

Dr. Michael Amster, pediatrician, will speak on concussions in young athletes at 7 p.m., on Tuesday, March 27, in Fauquier Hospital's Sycamore Room.

When Liberty High School freshman Emily Fitzwater reported blurry vision after a volleyball hit her hard under the chin, her mom, Becky, experienced a little déjà vu. The nosebleeds, headaches, the fuzzy thinking – she had seen this before.

Almost exactly a year before, Emily had taken a knee under the chin while sliding into home plate during a youth sports softball game. The results were the same: her head snapped back and the blurry vision and headaches followed. The diagnosis: concussion.

But Becky Fitzwater has noticed a world of difference in the way the two events were handled. Fauquier County Public Schools recently put a concussion protocol in place, and local coaches, trainers and physicians are better trained to recognize and treat concussions.

The first time Emily was injured, she returned to play in a softball game just three days later. The volleyball injury was treated much more conservatively. Becky Fitzwater said that Liberty High School’s trainer, Mandy Carter, was very concerned about Emily’s symptoms and directed that Emily undergo a thorough evaluation by her doctor as soon as possible. Emily’s mother said, “Dr. (Joshua) Jakum, Emily’s pediatrician, told us, ‘This is a bruise. You have to let bruises heal, especially if it involves a whole lot of brain cells.’ He told Emily, ‘You are to do nothing: no reading, no video, no cell phone. You can watch TV in 15-minute intervals, but if your vision becomes blurry, stop. You lie on your bed and listen to music.’ She slept the whole first day.”

After about four days, Emily realized her head didn’t hurt anymore but she was still not allowed to return to the volleyball court. It was only until she went a full week without symptoms that she was allowed to slowly resume activity. Becky Fitzwater said, “Because this was Emily’s second concussion, her doctor and the school’s trainer were very cautious, and they monitored her carefully for any return of her symptoms.”

Dr. Jakum is one of three clinicians in the county who have received special training on diagnosing and treating concussions; the other two are Dr. Michael Amster, pediatrician, and Dr. Mary Koralewski, psychiatrist. Dr. Jakum said, “If there is an injury, it’s important that the athlete is pulled off the field immediately and evaluated. Recognizing a concussion requires attention by coaches, athletic trainers and knowledgeable parents.”

Dr. Amster added, “Children with concussions often have difficulty recalling old information and learning new information. A child with a concussion not only needs physical rest, they need mental rest. Strenuous physical or mental activity can make concussion symptoms worse.”

He said, “For those younger than 24, if an athlete suffers a second concussion before fully recovering from an earlier one, it can cause the brain to swell and could result in significant brain damage.” Dr. Amster adds that only 40 percent of children
who have suffered concussions are fully recovered after a week.

Virginia’s concussion law, the Student-Athlete Protection Act (SB 652), was signed into law in April of 2010. The law mandated that schools develop a concussion policy by July 1, 2011 and Fauquier County School District’s health director, Pam Trude, coordinated the development of that new policy.

ImPACT Testing
The school system’s new rules require that all student athletes involved in sports undergo baseline ImPACT testing (Immediate Post-Concussion Assessment and Cognitive Testing). Drs. Jakum, Amster and Koralewski agreed to become ImPACT-certified clinicians.

ImPACT takes approximately 20 minutes to complete. The computer program measures multiple aspects of cognitive functioning in athletes, including:
• Attention span
• Working memory
• Sustained and selective attention time
• Response variability
• Non-verbal problem solving
• Reaction time

The test is given before the season to establish a baseline. If the athlete is injured and a concussion is suspected, school staff can administer the test again and compare results to the baseline to measure the change in cognitive function. This allows the physician to determine whether or not the athlete has suffered a concussion.

Joining the effort to diagnose and effectively treat concussions in young athletes, Fauquier Health has donated $6,550 to the Fauquier County School Division for 2012-2013 ImPACT testing.

Observable signs of a concussion
• Appears dazed or stunned
• Is confused about assignment or
• Forgets an instruction
• Is unsure of game, score or
• Moves clumsily
• Answers questions slowly
• Loses consciousness (even briefly)
• Shows mood, behavior or
personality changes
• Can’t recall events prior to hit or fall
• Can’t recall events after hit or fall
Signs of a Concussion that

Signs that may be reported by an athlete
• Headache or pressure in head
• Nausea or vomiting
• Balance problems or dizziness
• Double or blurry vision
• Sensitivity to light
• Sensitivity to noise
• Feeling sluggish, hazy, foggy
or groggy
• Concentration or memory problems
• Does not “feel right” or is
“feeling down”

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