ON THEIR MINDS

September 30, 2010 at 12:00a.m.

Parents, coaches on alert for head injuries

Milwaukee Journal Sentinel

From the professional ranks down to the peewee level in such contact sports as football and soccer, concussions are much on the minds of medical professionals, coaches, athletic administrators, parents and the athletes themselves.

On Sept. 12, during the game between the Green Bay Packers and the Philadelphia Eagles, viewers saw Eagles’ linebacker Stewart Bradley collapse on the field. He had suffered a concussion and was ruled out for the following weekend’s game. In the same game, Eagles quarterback Kevin Kolb had a concussion and was also benched for the following Sunday.

On Sept. 11, University of Wisconsin-Madison receiver David Gilreath was knocked unconscious and lay motionless in the school’s game against San Jose State. Gilreath was taken off the field on a stretcher and did not play the next Saturday when the Badgers met Arizona State University.

And earlier this month, Evan Coubal, a sixth-grader from Muskego, Wis., suffered a concussion during a youth football game. Days later, he was playing near a football sled when he hit his head on it. He was taken to a hospital, where he died of head trauma.

The three cases are all different, with one ending tragically. But while expert medical care is at the ready at the professional and collegiate levels, there is growing concern and awareness about the impact concussions have on young people. Recently, the U.S. House Education and Labor Committee was to discuss legislation to reduce and more safely manage concussions in young people.

Nationwide, the tally of concussions is going up because of increasing numbers of young people playing sports, better reporting and a greater awareness of the dangers of a head injury.

This month, the National Federation of State High School Associations estimated that 7.6 million young adults participated in high school sports nationwide, a record. But more kids mean more opportunity for injury.

Last month, a report in the journal Pediatrics found that the number of children in the nation seeking emergency medical care for concussions while playing sports more than doubled from 2000 to 2005. The study found that 40 percent of the pediatric concussion patients were between the ages of 8 and 13.

And one out of five will have symptoms lasting two weeks or more.

Altogether, anywhere from 1.8 million to 3.6 million athletes of all ages report symptoms of concussion each year, with the majority of concussions occurring among younger people.

At the professional and college level, doctors and medical professionals who have been trained to evaluate concussions are seconds away from a player on the field.

The Wisconsin Interscholastic Athletic Association, the governing body for high school sports in that state, has rules governing concussions. Athletes who display symptoms of concussion or who are unconscious cannot return to practice or competition the same day without a physician’s written approval. A doctor also must clear the athlete before he or she can return to competition afterward. And then there is a return-to-play protocol with provisions for gradually getting an athlete ready to participate full time.

The WIAA also has encouraged coaches, trainers, assistants and others to take a free online course offered by the National Federation of State High School Associations that provides more information about concussions.

But WIAA officials and medical experts admit it is unrealistic to assume that a trained medical professional can be at every game at each level.

Physician Kevin Walter, director of the Pediatric and Adolescent Sports Medicine Program at Children’s Hospital of Wisconsin in Wauwatosa, sees many of these young patients.

An expert on pediatric concussions, Dr. Walter runs the state’s only concussion clinic for children and young adults up to age 22. In his practice, he sees plenty of young athletes who have had a concussion but are desperate to get back and play again.

The research, he says, provides evidence that younger children’s brains are more susceptible to injury and may take longer to heal.

“Until recently, there wasn’t a good place to go for concussions,” he said. “People would go to the emergency room. We’ve set up this concussion clinic like a cardiology clinic or a neurology clinic.”

The challenge, he says, is that most medicine is evidence-based. “This is common sense and experienced-based medicine,” Dr. Walter said, adding that making the actual diagnosis is not difficult.

Often, Dr. Walter will meet young patients who are not completely honest about their symptoms. They want to play again, and soon.

In one recent case, a 12-year-old patient playing football had a concussion but stayed in the game. He got as far as the fourth quarter.

“He couldn’t track fingers,” Dr. Walter said.

As a doctor who has to rule on whether a young athlete is free to return to play, Dr. Walter says he has two rules: A player must be symptom-free and must pass a normal physical exam.

One of the tools he and others use is so-called baseline testing. Athletes are given a cognitive test before the season. After the athlete is injured, the test is administered again to see whether any issues pop up.

“Baseline testing is important and can be very helpful,” Dr. Walter said. “Parents look at the testing and they see them getting the answers wrong and they get scared. Now it becomes real and it sets in.”

And while medical experts can’t always be available, Dr. Walter and the WIAA have been encouraging coaches to learn more about concussion.

“The coaches need to be familiar and aware. Most people are. You have to seek that kid out and ask the questions, get a sense of how they answer,” he said.

“Is that tough for coaches? Yes, but they have to,” Dr. Walter said.