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Sudden impact: The growing issue of youth concussions

| Friday, Sept. 2, 2011

Haley Branovan's brain is stirred up.

She can't go to school at Culver Academy in Indiana or even send a text message without experiencing a headache, dizziness and nausea from a concussion she sustained while playing ice hockey.

On this day, though, Branovan, 16, of Wexford finally receives positive news.

"You will get better," Michael Collins, Ph.D., head of UPMC's Sports Concussion Program, tells her during an exam in Pittsburgh's South Side. "You will play hockey again."

As many as 3.8 million sports-related concussions occur annually in the United States -- an epidemic, according to the Centers for Disease Control and Prevention.

UPMC treats 10,000 concussion patients a year, or about 250 a week, and 70 percent to 80 percent are in high school or college, spokeswoman Susan Manko said.

As the high school football schedule gets under way tonight and other fall sports follow, it is the experiences of professional athletes like Penguins superstar Sidney Crosby that have shined a spotlight on concussions.

"It is the buzz word of sports," said Larry Cooper, a certified athletic trainer at Penn-Trafford High School and former member of the National Athletic Trainers' Association Secondary School Committee.

The increased attention might simply mean the public is becoming more educated about traumatic brain injuries, said Dr. Kevin Wong, president elect of the Pennsylvania Academy of Family Physicians.

"Scaring people with the term (brain injury), with all this information, isn't the worst thing," he said.

How states compare

The National Federation of State High School Associations (NFHS) which sets rules and guidelines for interscholastic sports and activities, recommends all high school athletes take a baseline cognitive test.

However, the Pennsylvania Interscholastic Athletic Association, the state's governing body for high school sports, does not mandate that its schools follow the recommendation.

Collins said patients are easier to treat if they have taken a baseline exam such as the locally developed ImPACT test. The 25-minute, computerized exam consists of six parts, relying on words, designs, shapes and colors to measure a person's normal brain activity. It costs $40, which parents -- not schools -- pay.

"The schools are responsible for the health and wellness of the students," said Tim O'Malley, executive director of the Western Pennsylvania Interscholastic Athletic League. "Most school districts, I do know, won't let their students participate without a baseline test."

Like Pennsylvania schools, athletic governing bodies in sports-minded Texas, Florida and Ohio told the Tribune-Review they also do not mandate baseline testing.

The PIAA and the WPIAL, a regional subsidiary, encourage but do not mandate that football coaches take the NFHS's 20-minute online concussion course.

Officials in Texas and Florida said coaches there must pass the NFHS test to coach this year. Ohio coaches, like those in the PIAA, do not have to meet such a requirement.

The PIAA and WPIAL are ahead of other states when it comes to having certified athletic trainers -- considered with coaches to be the first line in diagnosing concussions -- at school events.

Only six of 126 WPIAL football schools did not have an athletic trainer last fall, Cooper said, citing National Athletic Trainers' Association data. Eighty-two percent of PIAA schools used athletic trainers last year compared to 42 percent nationally, the data showed.

Dr. Jack Wilberger, chair of Allegheny General Hospital's neurosurgery department, said concussions will remain a health concern for athletes unless "you fundamentally change the way games are played."

Making changes

The Pennsylvania Interscholastic Hockey League, which does not fall under the much larger PIAA's oversight, has begun tracking concussions and other injuries. The league of 64 boys hockey schools passed a requirement this summer that players get a baseline cognitive test. Coaches must pass a course, and coaches and on-ice officials must attend an seminar on how to look for and handle concussions.

The PIHL is working to reclassify "freshman" status in an effort to keep like-sized players facing off against each other. Currently, the PIHL allows a hockey player from sixth through ninth grades to play freshman hockey. By fall 2013, ninth-graders will be eligible for only junior varsity or varsity.

"We've seen information from doctors who say an 11-year-old brain cannot process carrying the puck and taking a body check at the same time," said PIHL commissioner Ed Sam, "so we don't want kids that age going against older, bigger players."

Branovan sustained her concussion in July after being hit by an older girl at a 21-team hockey tournament in Marlborough, Mass. Her Team Pittsburgh U16 squad was "playing up" against teams with players as old as 19, she said.

After her concussion and initial visit to UPMC, doctors prescribed Branovan with medications that helped her return to a regular sleeping schedule. Rehabilitation activities such as tossing a tennis ball from hand to hand and lining beads on a string she held out from her nose helped improve her orientation, she said.

"When (Collins) said right away he would keep her out of school for a couple of months if necessary, that sort of hit a pressure point for me," said Scott Branovan, Haley's father. "I was scared. But hearing him promise she'd get better and play again was a relief."

Four days after seeing Collins, Haley Branovan said she was thinking again about playing hockey in her No. 12 jersey.

"I'm feeling better," she said, "so I can think like that."

Additional Information:

Concussion warning signs

Parents should take their children to the emergency room if they develop any of the following symptoms:

-- Headache, dizziness and/or unconsciousness

-- Confusion/disorientation, difficulty with memory and/or balance problems

-- Blurry vision, unequal pupil size and/or no pupil reaction to light

-- Drowsiness, slurred speech, tremors and/or convulsions

-- Nausea, vomiting and/or sensitivity to light or noise

Source: Allegheny General Hospital Sports Medicine

Additional Information:

Recovery tips

Children should follow these instructions to help recovery from a concussion:

-- Avoid texting, video games and MP3 player usage

-- Use only acetaminophen (Tylenol) to treat pain; avoid aspirin, ibuprofen and naproxen (Advil, Alleve)

-- Consume a light diet as tolerated

-- Get regular sleep

-- Avoid strenuous activity until receiving clearance from a medical professional

-- Place an ice pack on head/neck as needed for comfort

Source: Allegheny General Hospital Sports Medicine

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