Concussion In Youth Sports- Everchanging Care

As we prepare for the fall sports pre-season, it is important to revisit a major topic in youth sports; concussions. The CDC defines a concussion as “a disruption in the normal function of the brain that can be caused by a bump, blow, or jolt to the head, or by a hit to the body that causes the head and brain to move rapidly back and forth.” The incident rate of concussions continues to increase in youth sports, despite rule changes and equipment to make sports safer. This trend could be from new rules not being properly enforced, youth athletes are playing more sports which leads to an increased risk, and increased education leading to more athletes coming forward to report signs and symptoms when they occur. However, to continue to combat the upward trend, more schools are participating in baseline concussion testing, revised concussion evaluations, and an updated return to play progression.

Many schools and youth leagues take part in baseline concussion testing for their athletes ranging from paper evaluations to online-based programs to help determine an athlete’s baseline cognitive function. By having a baseline examination, medical professionals can compare a “normal,” athlete-specific exam to the athlete’s post-injury exam to determine if there are any deficiencies. This promotes more individualized, higher quality of care. One of the most popular programs is the ImPACT test. Baseline testing should be conducted by a healthcare professional, which is most often a Certified Athletic Trainer (ATC) who can help facilitate care between the athlete and the treating physician. ATCs also play a vital role in the initial stages of a head injury.

As society becomes more concerned with sports safety, particularly with regards to concussions, it is becoming more important to have ATCs attending sporting events. ATCs are able to provide a wide range of services including baseline concussion testing, sideline concussion assessment, and facilitate the return to play progression, while keeping up to date with the latest research.  In 2016, the new SCAT5, which includes medical red flags, observable signs, revised cervical spine assessment, a more in-depth background information section, and a revised cognitive and neurological assessment. Also introduced is a version of the SCAT5 for children under 12 years old, which provides a more age-appropriate examination. The New York State Public High School Athletic Association, or NYSPHAA, also has a concussion assessment form to serve as a basic evaluation, particularly useful in schools that may not have an ATC. Beyond assessments, NYSPHSAA and SCAT5 also provide guidelines for a safe return to play, which have also been revised for the coming school year. The NYSPHSAA recently released its updated policy regarding gradual return to play (RTP). The policy has been that an athlete must be symptom-free for 24 hours before beginning the RTP progression. Research has now shown that there are some symptoms that are acceptable while completing a RTP progression. These specific symptoms will be addressed only by the athlete’s treating physician, and relayed to the ATC. This is an important development that will alter how certain athletes are managed following a concussion. The RTP procedure takes five days to go from symptom-limiting activity to full contact/normal practice. In recent years, there has also been a greater emphasis on returning to academics.

Having the appropriate healthcare providers is essential in correctly managing a concussed athlete. Certified Athletic Trainers are often the first line of contact, conducting baseline testing or sideline evaluations, who then refer the athlete to a physician familiar with up to date concussion management protocols.