High school senior Michael Espinel, a defensive player for Belen Jesuit Preparatory’s football team, has suffered three concussions in two seasons.
In November 2009, Belen was practicing for the state championship semi-finals. Michael received a blow to the head during a drill, momentarily numbing half of his body.
“I felt like I was in a dark room, with a light shining in my face. My head hurt so badly,” said Espinel, then a sophomore.
He returned to the practice field anyway, and five minutes later he collapsed, unconscious.
Two pivotal new measures being rolled out in South Florida are intended to prevent scenarios like that.
The Florida High School Athletics Association (FHSAA), which governs high school sports throughout the state, is implementing new guidelines to keep athletes suspected of sustaining a concussion from returning to the field without a doctor’s OK.
In addition, high school students who play on interscholastic teams in Miami-Dade and Broward counties will take a baseline cognitive test in the pre-season to determine the extent of a concussion and monitor their recovery should they suffer a head injury.
Both changes are aimed at keeping injured players off the field until fully recovered, helping to prevent the cumulative effects of multiple concussions.
“Injuries on the brain, especially the ones that go untreated at a young age, have a much greater impact on society than we’ve been previously willing to admit,” said Dr. Kester Nedd, director of Neurological Rehabilitation at the University of Miami’s Sports Medicine Center.
“Beyond headaches and dizziness, any traumatic brain injury can potentially affect personality and interpersonal relationships.”
One such long-term consequence is Chronic Traumatic Encephalopathy (CTE), a degenerative brain disease, according to Dr. Ann McKee, head neuropathologist of a brain bank at the Bedford Veterans Administration Medical Center in Massachusetts.
“Multiple injuries on top of previously untreated injuries – that’s where the danger builds up,” McKee said.
Assessing a concussion’s severity and determining proper treatment can be difficult. When a kid takes a bump to the head, finer cognitive functions such as memory are usually the first to go and the last to come back, Nedd said.
The test being phased in for Miami-Dade high school athletes — called Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) — takes 30 minutes and is administered online. Test takers perform a series of tasks that measure cognitive functions such as memory recall, attention span, non-verbal problem solving and reaction time.
Once an athlete is suspected of suffering a concussion, an ImPACT retest is administered, and scores are compared. Along with a neurological exam, the results can aid a doctor in determining whether an athlete is fit to return to the playing field.
Nedd and his colleague Dr. Gillian Hotz, who run The Miami Project to Cure Paralysis Concussion Clinic at the University of Miami, have been pushing for years to have high school athletes tested.
The cost to individual schools — estimated at $600 annually — had stood in the way, but David Goldstein, an incoming junior at Ransom Everglades School in Coconut Grove, helped change that.
Goldstein, a soccer player, suffered his third concussion in four years in January 2010 in a head-to-head collision during district finals. He stayed in the game – and spent the next three months with incapacitating headaches and a loss of balance.
“After the hit, I finished the game and practiced the next day. Even me, who had had two concussions already, I wasn’t properly educated. I thought maybe I had a cold. It wasn’t until I collapsed from pain after practice the next day that I realized something was wrong,” Goldstein said.
After seeing several doctors and being told he could never again play soccer, Goldstein was referred to Hotz and Nedd. They put him on the road to rehabilitation after discovering that he had suffered inner ear damage.
They also introduced him to ImPACT testing, which Goldstein brought to the attention of the athletic director at his school, Claude Grubair.
Ransom adopted ImPACT testing for its athletes, and Goldstein decided to bring baseline testing to Miami-Dade public schools. He founded the Countywide Concussion Care project, which has raised $35,000.
The money has gone to the KiDZ Neuroscience Center at the Miami Project to Cure Paralysis at the University of Miami’s Sports Medicine Center, where Hotz has purchased tests in bulk for schools to administer.
Hotz and Nedd will also be responsible for clearing all athletes to play post-injury.
“I will not clear a kid over the Internet; they’ll have to come in. ImPACT will help, but we need to see them,” said Hotz.
All Miami-Dade high school athletes eligible to play spring football were tested in May, and testing is being expanded to volleyball players, soccer, wrestling, basketball, softball and lacrosse. About 2,800 students have been tested so far.
“We eventually want to expand to other sports, but crunch time right now is focused on contact sports,” said Cheryl Golden, instructional supervisor for Miami-Dade Schools.
Broward County schools are implementing mandatory ImPACT testing for high school football players countywide next year.
“This was an automatic call for me with concussions and return to play being such a hot button issue,” said Damian Huttenhoff, director of Athletics and Activities for Broward schools.
A University of Pittsburgh grant is paying for a year’s worth of tests, and injured athletes will be followed by doctors at Nova Southeastern University. Once the grant runs out, the county will pay for ImPACT.
With an estimated 15,000 athletes in Broward, Huttenhoff said, the county can’t yet guarantee that testing will be available to athletes in all contact sports, but “the ultimate goal is to have 100 percent tested.”
In addition to requiring that players with suspected head injuries be taken off the field immediately and not returned without medical clearance, the FHSAA is requiring that all coaches receive additional concussion management and recognition training.
“We need smarter parents, coaches and athletes,” said Valerie Breen, director of the Brain Injury Association of Florida. “Long-term change is going to require a change in the sports culture.”
For its part, Belen, a private school, began baseline testing of its football players this summer. For some time, the school has offered all previously concussed players helmets designed to protect against concussive hits.
Once he is cleared by Dr. Nedd, Espinel plans to finish out the season with his team. But he’s decided against trying to play college ball.
Source : Miami Herald