Managing the Student-athlete Suffering From Concussion: Is it Worth The Headache?

By Jason Mihalik

Concussions are common in high school athletics. Some national estimates from the Centers for Disease Control and Prevention indicate that as many as 1.6 to 3.8 million mild traumatic brain injuries are sustained each year in the United States alone. While most of us are familiar with news media footage of concussions sustained by professional athletes, the reality is that as many as 5,000 concussions are sustained at the high school and youth levels for every concussion sustained in the professional ranks. Given there are currently more than seven million participants in high school sports in the United States, many administrators, teachers, school nurses, high school coaches and certified athletic trainers should be aware of the possible complications of this injury for the high school student-athlete.

What is concussion and what are some of the things you should expect?

To put it simply, a concussion is a type of brain injury. A number of signs and symptoms may be experienced by the student-athlete including, but not limited to, headache, nausea, dizziness, confusion, balance problems, difficulty concentrating, and problems related to memory, mood and fatigue. Concussion is usually the result of either a direct blow to the head (very common in football and soccer heading), or through a whiplash-type mechanism through a body collision or even automobile accident. The injury is frequently referred to as the "hidden epidemic" and is often minimized since structural deformities are almost always not observed on CT or MRI scans.

How can administrators help the student-athlete suffering from concussion?

As with any injury, being adequately prepared to handle a medical emergency is usually the best policy. Since most of these injuries will typically result from participating in varsity and junior varsity athletics, experts highly encourage every high school to retain the services of a Certified Athletic Trainer (ATC). All ATCs have completed rigorous university-level coursework, are regulated and licensed health-care workers, and certified by an independent national board. Not unlike other professions schools may already have on staff (e.g., physical, occupational, speech and language therapists), all ATCs have at a minimum a bachelor's degree from an accredited college or university. The reality is that more than 70 percent of all ATCs have a master's degree or doctorate. While they are excellent at identifying and managing concussions, they are also trained in emergency care, as well as the evaluation and rehabilitation of orthopaedic conditions your student-athletes may suffer.
Since concussions are not reserved for the student-athlete, but may afflict a large number of physical education students, and even those who sustain off-campus injuries (e.g., cycling, motor vehicle and skateboarding accidents, to name a few), educating your faculty and auxiliary staff in this condition can be especially useful to the high school administrator.

What should teachers know about concussion?

One aspect of the management of sports-related concussions often overlooked is that we expect our students to perform at their highest level in the classroom following injury. This is true despite the fact that concussion often results in impaired attention, difficulties with concentrating for prolonged periods of time and memory problems. If a student sprains his or her ankle and it is swollen, would one force the student to participate in physical education? No. The same should be true for concussion: if prolonged classroom exposure causes a student's condition to worsen (i.e., headache worsens, fatigue levels increase, concentration decreases), then why should we expect a student to attend regular classes and the like?

There are many management strategies the teacher can implement in maximizing the classroom development of the injured student-athlete. First, in order to counteract attention and concentration problems, shorter assignments and a lighter workload may prove beneficial to the student-athlete. Second, repetition and the use of written instructions may help the student-athlete experiencing "working memory" issues. Third, the teacher can focus on recognition cues and providing smaller pieces of information to retain for those experiencing difficulties with memory consolidation and retrieval. Since processing speed can often be affected following a concussion, time extensions on homework assignments, slowed-down verbal instructions and more reinforced comprehension-checking is often warranted.

What role does the athletic trainer play in the management of concussion?

Notwithstanding their importance in the recognition and management of all athletic injuries that may be sustained by student-athletes during school-sanctioned events, the Certified Athletic Trainer can play an integral role in the education of the student-athlete. Many high schools and colleges across the country have implemented preseason baseline screening for cognitive function, mental status and balance assessment. If an athlete is suspected of having sustained a concussion, they are re-evaluated on these same measures and their post-injury scores are compared to their healthy preseason data. While this is a critical piece of the puzzle many ATCs find valuable in the management of concussion, the cognitive testing available to ATCs is often very similar to that used by learning specialists at your school. Every year, more high schools are adding Certified Athletic Trainers to their staffs to help deal with these health concerns. Administrators, teachers, parents, coaches, players and auxiliary school staff all share a common goal: to provide the best learning environment and social infrastructure to develop the future generations that will one day grow to be significant contributors to our society. The Certified Athletic Trainer fits very nicely in this role and I encourage all of you to explore the possibilities of retaining these highly skilled professionals in your institutions.

Jason P. Mihalik, MS, CAT(C), ATC, is a fourth-year doctoral student in human movement science at The University of North Carolina located in Chapel Hill, North Carolina. The study of sports-related concussion remains his primary area of research. He completed his graduate studies in sports medicine at the University of Pittsburgh, where he served as the head athletic trainer for two high schools in the Pittsburgh Public Schools System. A native of Canada, he completed his undergraduate degree at Concordia University in Quebec, Canada, in exercise science. He has been a Certified Athletic Therapist in Canada since December 2001, and a Certified Athletic Trainer in the United States since April 2002.