University of Miami program targets concussions – Miami Herald


University of Miami program targets concussions in young athletes

If your high school son or daughter gets knocked in the head on the playing field anywhere in Miami-Dade, chances are Dr. Gillian Hotz and her colleague Dr. Kester Nedd will soon be on your speed dial.

The two have teamed up to spread the word on concussions and push for high school athletes to be tested before an injury occurs, thus establishing a baseline that will help determine treatment and assess their recovery.

At the start of the 2009 school year, Hotz said she was seeing three to four young athletes a week at the clinic at the University of Miami Hospital. This year, she’s seeing about 14 or 15 kids a week who have head injuries from playing football, soccer and other sports.

It’s not that the sports have become more dangerous. On the contrary, sports equipment is improving, said Vincent Scavo, who spent 17 years in the Miami-Dade County Schools system as an athletic trainer.

“What’s happening now is we’re educating people better,” Scavo said. “The way we handled equipment years ago was we gave the athlete a helmet and said, `Go play.’ Now, we’re conscious of how we fit the helmet. . . . That’s so important today. The hitting is unbelievable — even at the high school level.”

Scavo’s son Alec is a senior and defensive lineman on the football team at Christopher Columbus High School.

Hotz and Scavo, now the director of Sports Medicine Services at the University of Miami Miller School of Medicine, attribute the increase in clinic visits to better awareness and education. Teachers and coaches have been trained to identify concussion symptoms, which include headaches, dizziness and vision problems.

“A few years ago people had a headache or some type of concussion symptom and they would ignore it and say they are fine,” Scavo said. “We realize now that’s not the way to go. Concussions are dangerous. Athletes don’t want to come out of the game. That’s why it’s so important that athletic trainers deal with athletes and teachers to educate the athlete and say, `It’s OK, you have a problem, we’ll get you better.’ ”

But more needs to be done.

Along with The Miami Project to Cure Paralysis, Ransom Everglades in Coconut Grove has teamed with the UM to increase awareness of concussions in sports and raise money to help schools in Miami-Dade adopt ImPACT testing. The goal is to get a baseline reading for all public high school football players next year.

So far, Ransom, Miami Palmetto Senior High, G. Holmes Braddock Senior High and Terra Environmental Research Institute offer ImPACT baseline testing for its student athletes. Colleges and the NFL also use the program.

“ImPACT is an amazing tool, a positive step forward,” said Cheryl Golden, instructional supervisor for Miami-Dade County Public Schools. “Head injuries are an enigma to parents, coaches and kids. It’s not like a broken bone that you can X-ray. With a concussion you don’t have physical proof and that’s what makes ImPACT so valuable.”

Students are tested by answering questions in a computer program; the questions revolve around memory, reflex and timed situations. The ImPACT materials can cost about $600 per school.

“It’s tough for these schools, they don’t have resources,” Hotz said. “They are doing the best they can. Some of these programs in rural parks don’t have a trainer. It’s a dad or a neighbor that’s a coach. If a kid’s really not right, he’s got to be seen, he’s got to be followed, and the school has to play a role in that. They are the gatekeeper.”

David Goldstein, 15, has become one such gatekeeper.

In September, the Ransom 10th-grader addressed representatives from The Miami Project, joining with speaker Marc Buonoconti, a Citadel University football player who was paralyzed during a game in 1985.

Goldstein introduced his school to the work done at the UM clinic after he suffered his third head injury in four years while playing soccer in January.

“I struggled with my situation for a long time. I found doctors Hotz and Nedd here at the Sports Medical Center and they helped me out,” Goldstein said.

The first step in his rehabilitation was ImPACT’s 30-minute computerized test to gauge his motor skills and to determine how serious his head injury was.

“My mental skills were nowhere near what they should have been,” Goldstein said. “They helped me out by finally getting me on medicine. I had a timeline of what to do when and how to come back from the injury. They introduced me to concussion testing.”

Quite a difference from months earlier. After Goldstein’s accident on the field, he practiced the next day.

“I got into the car after and collapsed under the pain,” he said. “I couldn’t move. I went to a couple neurologists who said I should never play soccer again,” he said.

“I’ve played since I was 4. To think I couldn’t play again devastated me. I thought I would wait it out but after three to four months I was having so much pain I had to sleep through a couple periods of school a day,” Goldstein said.

His mission now: Make baseline testing the norm at all schools by the 2011-2012 year.

For a 10-year period ending in 2007, the American Academy of Pediatrics tracked emergency room visits for concussion in children ages 8 to 13 and for teenagers who are all involved in organized sports. Emergency room visits among the younger group doubled and increased by more than 200 percent among the teens. More than 500,000 visits were reported for the combined groups.

Part of the reason for the increase, Nedd says, is the evolution of awareness and treatment. Concussions, and the push for baseline testing of student athletes, has received national attention.

Nedd acknowledged that injuries can’t be completely avoided in contact sports like boxing and football.

“The real issue is the long-term impact on people’s lives. Can they return to work? At school, can they perform at a level that will be deemed acceptable? The interpersonal relationships. When you look at pro athletes and the problems they have, a lot of time they have unrecognizable head injuries they received in junior high and high school. Even mild head injuries affect personality.”

The formative pre-teen and teen years can be most critical, Nedd said.

“Some of the ills we have in society may have a basis in an injury to the brain at an early age.”

Nicholas Johnson, a 10th-grade defensive end at Coral Gables High, sits on an examination table inside the University of Miami Hospital on a recent Tuesday afternoon.

The preceding Wednesday, he suffered a head injury during a football game.

“One of the players on the other team hit me helmet to helmet at least six times,” said Johnson, 15.

He wasn’t overly concerned during the excitement of the game, he said. “I got up, didn’t think much of it and went back to the huddle. It didn’t bother me until I got home that night.”

Thursday, his vision blurred, he couldn’t concentrate on a test in sixth period and his head started to hurt.

That first night, his mother recommended that Nicholas check in with Coral Gables’ athletic trainer, who prescribed immediate rest and set up an appointment for Nicholas at the UM clinic to undergo testing.

“I was glad to see they are very conscientious and were paying close attention to what’s happening with him,” said his mother, Doris Johnson.

Lacking a baseline score, the doctors ran Nicholas through a series of tests, both paper and pencil question-and-answer, and neurological tests of motor skills.

The verdict? An inner ear injury. No football until further tests show a return to normalcy.

“I’m upset because tomorrow is one of our biggest games against Columbus and I can’t play,” Nicholas said.

It could be worse.

“Some families freak out,” Hotz said. “I’ve had 200-pound kids crying that they are out of football. If they reach baseline, with no symptoms, we’ll clear them. But every kid, every hit is different.”

Source : Miami Herald

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