Brain Injury Law Blog : Head Injury : Coma : Personal Injury : Las Vegas Nevada Lawyer & Attorney Tim Titolo

I was reviewing Feeds from the Center for Disease Control and came across this "Return to Play Progression."  Young athletes, as well as professional athletes, need protection while in the heat of the moment.  Coaches and Health Care providers can control crucial decisions as discussed below.

 Baseline (Step 0): As the baseline step of the Return to Play Progression, the athlete needs to have completed physical and cognitive rest and not be experiencing concussion symptoms for a minimum of 24 hours. Keep in mind, the younger the athlete, the more conservative the treatment.

Step 1: Light Aerobic Exercise
The Goal: only to increase an athlete’s heart rate.
The Time: 5 to 10 minutes.
The Activities: exercise bike, walking, or light jogging.
Absolutely no weight lifting, jumping or hard running.

Step 2: Moderate Exercise
The Goal: limited body and head movement.
The Time: Reduced from typical routine
The Activities: moderate jogging, brief running, moderate-intensity stationary biking, and moderate-intensity weightlifting

Step 3: Non-contact Exercise
The Goal: more intense but non-contact
The Time: Close to Typical Routine
The Activities: running, high-intensity stationary biking, the player’s regular weightlifting routine, and non-contact sport-specific drills. This stage may add some cognitive component to practice in addition to the aerobic and movement components introduced in Steps 1 and 2.

Step 4: Practice
The Goal: Reintegrate in full contact practice.

Step 5: Play
The Goal: Return to competition

The Center for Disease Control espouses that an athlete should be free of symptoms prior to being put back into play.  If symptoms are present, the athlete should not be put back into play for at least 24 hours.  A health care provider should carefully monitor the athlete after injury.

Online training for Health Care Professionals can be accessed here.  Health Care Professionals can access state, league, or sports governing body’s laws or policies on concussion.

Protecting our kids and teens from concussions should be a priority. Check out An International Consensus Statement on Concussion in Sport: the 3rd International Conference on Concussion in Sport held in Zurich, November 2008.

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The Las Vegas Review Journal did a piece on concussion in contact sports.  Education is key.  Learn the risks and how to prevent injury.

...concussions, when sudden trauma causes damages to the brain, are a common injury to the head in contact sports, and an estimated 3 million sports-related concussions happen every year in the United States, according to the Centers for Disease Control and Prevention.

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Following up on the recent post on this blog about traumatic brain injury in sports and repetitive injury, the Las Vegas Review Journal devoted a lengthy article on what Clark County Public Schools are doing to protect its athletes.

All too often, student athletes are put back into play with an unresolved concussion.  This becomes a repetitive injury situation where pugilistic Parkinson's develops later in life.  Emphasis in professional sport brain injury in boxing and football has trickled down into the high school and college setting.

 "The school district's procedure issued in August 2008 expanded rules for head injury management that were already in place. The procedure states that an athlete who has suffered a concussion cannot return to practice or competition until having clearance from a physician, an approved score on a computerized neurocognitive test called ImPACT..."

"Schools around the country have begun using the ImPACT assessment to help gauge an athlete's recovery from a concussion. Clark County athletic trainers said the test is invaluable."...

Photo by DAVID STROUD/LAS VEGAS REVIEW-JOURNAL

"Freshmen athletes in the school district are charged a $5 fee to take the test. The initial exam is called a "baseline test" because results are compared to a later test the athlete takes after they have suffered a concussion.

The test consists of six components: word memory, design memory, X's and O's matching, matching shapes to numbers, matching colors and counting backwards from 25 to 1 while remembering letters."  These tests are similar, on a summary level,  to full battery neuropsychological testing done by experts in that field.

Congress voted to set Federal Guidelines for managing concussions in student athletes.  The bill, known as Concussion Treatment and Care Tools Act, requires a government organized conference within two years for medical and athletic officials to set the guidelines.

University of Nevada Las Vegas is also making concussion awareness a priority.  

"In April, the NCAA Executive Committee adopted a policy requiring schools to have a concussion management plan that required the removal of an athlete who showed any signs of a concussion in practice or an event.

UNLV, meanwhile, is in its fourth year of administering a neurocognitive test to its athletes similar to the one used in local high schools, said Kyle Wilson, UNLV's director of athletics training.

'One of the big problems is, if someone has a head injury, you can't see that,' Wilson said. 'That's why we've incorporated some of the 'baseline' testing.'

Comparison of baseline with post injury status is the key to understanding when and when not to put a player back into play.  This is true of all brain injury however is not always available.  In other words, in known risk activity such as contact sports, blast injury, getting baseline cognitive testing is a somewhat prophylactic effort.  But in cases of car accident, fall and other less risky activity, likely brain injury is not expected and no baseline neurocognitive testing is available.

Local neuropsychologists, Thomas Kinsora, Ph.D. and Staci Ross, Ph.D., helped develop the ImPACT test used in high schools and run Sports Concussion Specialists of Nevada.  They believe the baseline testing is crucial because of the variability of symptoms in brain injury. 

 

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Please Click here to link to an interesting resource on Concussions related to Youth Sports.  Now that school is back in full swing it would be wise to refamiliarize with the issues applicable to our kids.

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The San Marcos school's principal Brad Lichtman and head football coach Chris Hauser announced Wednesday that after reviewing tapes of the game against West Hills, there is no obvious traumatic incident.


"It did not appear in our first review of that tape that I as a layperson would say that caused that injury," Lichtman said.

Scott Eveland went over to the sideline and was stumbling around early in the second quarter, and administrators said there wasn't very much tape to look at. But they said they did not see Eveland make helmet-to-helmet contact with anyone.

School officials said Eveland was not knocked down and wasn't at the bottom of a pileup.

Meanwhile, a recently released letter shows how much gratitude Eveland had for his parents. The honors student typed it shortly before he slipped into the coma.

"You did a very good job raising me and I hope to achieve what you two have so far," Eveland wrote in the letter.

Lichtman read a statement from Eveland's parents that said, "We continue to be thankful for all the gracious love and support from the community, including well-wishers from all local high schools, and cards from friends and classmates."

Hauser said the team is staying focused, but none of them have ever gone through this before.

"Three Escondido football players came by yesterday's practice and brought over a poster with all of them signed," Hauser said. "Valley center signed a poster and brought it here from their boys. At the hospital today, San Pasqual dropped off a card with all of their teams' signatures on it."

Eveland remains in an induced coma in critical condition at Palomar Medical Center

Watch video by clicking here.

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The New York Times published a great article about the dangers associated with not recognizing the signs and warnings associated with Football injury.  Too often sporting goals prompt those who could make a difference dealing with injuries to fail players and themselves.  The issues of multiple impacts and multiple concussions seen in many contact sports like football and boxing are getting more and more attention.

The National Football League has recently faced questions about its handling of concussions after four former players were found to have significant brain damage as early as their mid-30s. But teenagers are more susceptible to immediate harm from such injuries because, studies show, their brain tissue is less developed than adults’ and more easily damaged. High school players also typically receive less capable medical care, or none at all.

At least 50 high school or younger football players in more than 20 states since 1997 have been killed or have sustained serious head injuries on the field, according to research by The New York Times.

Read the full article click here

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