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Thursday, July 31, 2014

MDMC conquers concussion management

Sunday, September 12, 2004

(Photo)
Traditional ways of examining for a concussion, such as looking at the pupils, doesn't always tell the entire story.
SIKESTON - As a certified athletic trainer for Missouri Delta Medical Center's ReStart, Amy Gordin knew, for example, how to assess a knee injury and determine how long before the athlete could safely return to their sport.

But up until now, concussion management has always been more subjective.

"Concussions are one of the most mismanaged sports injuries," Gordin said.

ReStart's new Immediate Post-concussion Assessment and Cognitive Testing program, or "ImPACT" for short, was established to change that for area athletes.

In July, Gordin went to the University of Pittsburgh, well-known among medical professionals for its cutting-edge concussion management techniques, to study concussion management and set up a program here. "We have got to have this for area athletes," Gordin decided. "We just want to manage concussions appropriately."

As with all sports injuries, the key component to concussion management is determining when it is safe to return to normal activity.

Sports trainers and medical professionals know that a concussion can affect things like reaction time, verbal and visual memory, problem solving skills, retrieval and processing speed in a victim, but assessment techniques are generally not standardized and assessment has been far from objective.

Using a battery of six tests, ImPACT's computer program takes the guesswork out of evaluating the athlete by comparing test results to age-specific "normal" scores or, even better, to a baseline score specific to the athlete recorded in advance.

"Ideally I would like to baseline test all athletes involved in contact or collision sports," Gordin said. Additionally, baseline testing has value for those involved in "any activity in which there is a high risk of concussion."

Activities such as football, basketball, soccer and martial arts have obvious risks. But concussions can and do happen in other athletic activities such as swimming or even cheerleading.

"It costs $10 to do a baseline," Gordin said. "It's one of those things you hope you will never have to refer back to."

A baseline test provides the objective measures to help determine when it is truly safe to return to normal activity.

Unlike most sports injuries, an athlete who has suffered a concussion may not have a clear indication of how they are really doing. Blows to the head are often brushed off by saying the athletes just "got their bell rung," Gordin said. "Coaches need to know that concussions need to be managed."

Like any other sports injury, there is significant risk of making the injury even worse by continuing an activity.

"If you don't let the brain heal, it just doesn't take much the second time to cause a concussion - especially in kids," Gordin said. "Both of the people I have in the program right now have had two concussions."

Mari Ann Moyers said she didn't even know her daughter had received the first concussion which was caused by a "freak accident" during lifeguard training. Her daughter, Meredyth, was hit in the head by a 10-pound brick that slipped from an instructor's hand as she was tossing it into the pool for another lifeguard trainee to recover. "It knocked her unconscious," Moyers said.

To the casual observer, Meredyth seemed completely normal, Moyers said.

"She didn't remember the incident," Moyers recalled. "She just came home, said she was tired and went to sleep."

Ten days later, she sustained a second concussion after being kicked in the same place during soccer practice. "It knocked her out again," Moyers said. As is often the case, the second concussion was "much more severe," Moyers said.

Moyer soon noticed things such as an increase in Meredyth's stress level. Usually at the top of her class, Meredyth's had trouble maintaining her grades.

"She was very, very frustrated and her memory loss increased a lot," Moyers recalled. "She couldn't do things and she didn't know why."

Examining the victim's pupils to see if they are different sizes and how fast they dilate and contract is a well-known method of checking for a concussion, but it isn't always reliable.

When Meredyth got her concussion, "her pupils didn't do that until the next day," Moyers said.

"Often even MRI's or CAT scans don't show anything, yet they have huge brain malfunction," Gordin said.

Fortunately, a school nurse at Sikeston Senior High called Moyers after seeing Gordin demonstrate the ImPACT software at the high school's health fair.

"It's wonderful," Moyers said of the ImPACT program. "It's something tangible we can look at instead of guessing. We can see specifically how she's doing."

In addition to assessment, proper management of concussions involves limiting activities to minimize the symptoms of a concussion which can include nausea, vomiting, concentration problems, memory problems, irritability, depression, anxiety and sensitivity to light or noise.

Those suffering from a concussion are also prone to overstimulation from anything from loud music to stress.

How long a concussion should be managed varies. "Each one is so different," Gordin said. "Meredyth's concussion was in March and we're still very much managing it."

For more information about the ImPACT program or to schedule a baseline testing session, call Gordin at 472-7375.