Proposed Maryland Legislation to Protect Student Athletes from the Dangerous Effects of Concussions

In the wake of concussions sidelining high-profile National Football League players such as Green Bay Packers quarterback Aaron Rodgers and Pittsburgh Steelers tight end Heath Miller, public awareness has grown about the detrimental effects a concussion has on the physical and mental well-being of athletes.

Concussions don’t just affect high-profile professional athletes, but student athletes as well.

Each year, U.S. emergency departments treat an estimated 135,000 sports- and recreation-related traumatic brain injuries, including concussions, among children ages 5 to 18, according to the Centers for Disease Control and Prevention.

This has led to a call from doctors, parents and coaches from across the nation for state governments to implement legislation for improved safety and educational standards regarding how concussions are diagnosed and treated.

Maryland is one of a number of states considering such legislation. Legislators in both the House of Delegates and Senate have introduced bills that will protect student athletes from the dangerous effects of concussions.

The House of Delegates bill (HB 858) would require a student athlete to be removed from practice or play following a suspected concussion; he or she will only be allowed to return after clearance by a licensed health care provider. It would also require the Maryland State Department of Education to develop an awareness and training program for coaches, school personnel, student-athletes and parents/guardians. Additionally, a student athlete and parent/guardian would sign an information sheet and acknowledgment statement before participating in a sport. The Senate bill (SB 771) has similar language.

LifeBridge Health has joined the NFL, the Brain Injury Association of Maryland and other organizations in support of this legislation.

Kevin Crutchfield, M.D., a neurologist with at the Sandra & Malcolm Berman Brain & Spine Institute at LifeBridge Health, spoke in support of the legislation at a hearing last week in Annapolis.

“We need the concussion bills passed to protect the children of Maryland today, while we accelerate our education efforts around the state regarding the dangers of athletic participation with an injured brain,” he said.

Crutchfield is director of the Comprehensive Sports Concussion Program at the Brain & Spine Institute. He is considered one of the nation’s leading experts on the effects of concussions on athletes. He serves on the NFL Player Association’s return-to play committee and as an independent neurologist for the NFL’s Baltimore Ravens.

Both Maryland bills are expected to go to a vote in the next few weeks.

-Noel Lloyd

Keeping Your Head: The Most Dangerous Games

by Mark Huslage, LCSW-C, CBIST
Coordinator of Brain Injury Programs, LifeBridge Health

As stories like this show us, emergency room visits are rising for concussions among student athletes. While we often focus on the risks of football, that's only one of many sports that place players at risk for significant neurological injury such as mild traumatic brain injury (mTBI) or “concussion.”

Fall sports such as soccer, lacrosse and cheerleading have high rates of concussive injury, especially as the age and athletic abilities of participants increase. Thankfully, with the increasing awareness of parents, players and coaches, along with coordinated medical approaches at places like the Comprehensive Sports Concussion Program at The Sandra and Malcolm Berman Brain & Spine Institute, improved management of mTBI continues to emerge.

“It’s all about concussion awareness and paying attention on everyone’s part," says Kevin Crutchfield, M.D., director of the Comprehensive Sports Concussion Program at the Sandra and Malcolm Berman Brain & Spine Institute. “There are great pressures on athletes and coaches to play through injury to demonstrate dedication and the desire to win. Someone has to be willing to protect the player from further harm.”

A period of rest is needed in all cases of diagnosed concussion, with some requiring weeks or months of layoff from competitive play.

“For those student athletes who experience memory and thinking problems, temporary classroom accommodations may be needed, as well,” adds Brain and Spine Institute neuropsychologist Julie O’Reilly, Psy.D. “Families should feel empowered to make such requests, as needed.”

Despite recent advances in concussion management, there continue to be injuries that cause long-term physical, cognitive and behavioral effects. Mild traumatic brain injury has been increasingly diagnosed in workplace accidents, motor vehicle accidents and on the battlefield. Slips and falls in at-risk populations add to this burgeoning epidemic. With concussions representing 80 percent of all brain injuries in the U.S., the need for specialized care is readily apparent.

“Many of the people we see in the Mild Brain Injury Program here at Sinai received inadequate medical attention at the time of injury,” says MBI Case Manager Linda Hutchinson-Troyer. “Some went undiagnosed, while others were given only minimal care, with little aftercare instruction.” Experts in the field agree that much of the long-term effects of concussion would be diminished if early management was consistently practiced.

Health care professionals are encouraged to learn more at Sinai Rehabilitation Center's one-day conference on the diagnosis and treatment of mTBI, "Not 'Just a Concussion'—Understanding Mild Brain Injury and Its Management. " This presentation will focus on the medical, neuropsychological and clinical interventions that promote a full and speedy recovery. To register or for more information, click here.

College Athletes Gear Up For Fall

The typical high school senior may be yearning for the day when she can start slacking – on school, on household chores, and on staying in shape.

But for student athletes like Susannah Feinstein, the college acceptance letter didn’t mean any less pressure. If anything, she stepped up her game.

Feinstein, who starts as a freshman at University of Pittsburgh this week, spent the spring of her senior year improving on her track times in order to become a part of the university’s Division 1 Track and Cross Country team. By committing to her training, she was able to get her times low enough to be accepted onto the team.

“It’s intense training,” she says. “There’s a lot of discipline involved with long-distance running. But it’s really good stress relief, and important part of maintaining my mental health.”

Sinai neurologist Kevin Crutchfield says that discipline and commitment to a sport can result to a college freshman having more direction.

“Athletics at the college level keep children focused and makes them time efficient,” he says.

Crutchfield, the director of the Comprehensive Sports Concussion Program at the Sandra and Malcolm Berman Brain & Spine Institute of LifeBridge Health and a former college athlete himself, works with a number of student and professional athletes. In addition to his treatment of those who are brain injured, Crutchfield talks to players about the prevention of brain injury. The secret to keeping both brain and body healthy lies in training, Crutchfield says.

“In the spring, I talk about training and off-season fitness,” he says. “This is especially true in areas such as football, where I tell the players ‘you need to get in shape now.’ Otherwise, being slower and having slow reaction times can lead to injury.”

With the absence of parents, sleep deprivation, missing meals and drinking can become a problem for any college freshman. But the consequences for a collegiate player can be dire.

“You can’t do the typical partying because your body won’t be okay for practice,” Feinstein says. “You need to take a holistic approach to staying healthy, including drinking a lot of water, doing weight training and avoiding repetitive motion.” Plus, any NCAA athlete like Feinstein will need to follow requirements such as having a sports physical, maintaining a certain GPA, and having random drug testing.

Feinstein says that she's looking forward to being a member of the team, even as she juggles three hours of daily practice with an intense college program in nursing.

“I love running. I plan to be on the team all four years,” she says.

Sinai Hospital Auxiliary Awards Grant to Comprehensive Sports Concussion Program

The Comprehensive Sports Concussion Program (CSCP) at LifeBridge Health has been awarded a $5,800 grant by the Sinai Hospital Auxiliary. Designed to diagnose and treat sports-related concussions with the most optimal treatment, the CSCP is a collaboration between LifeBridge Sports Medicine, the Sandra and Malcolm Berman Brain & Spine Institute, and the Sinai Rehabilitation Center.

The CSCP will use the funds to support the prevention, diagnosis, and treatment of concussions in student-athletes at schools in underserved communities that surround Sinai Hospital.

“We are honored to have received this award. It provides us an exciting opportunity to identify student-athletes in need of intervention, to promote their recovery and to help them keep pace in class while they are recovering from their concussive symptoms,” said Julie O’Reilly, Ph.D., a neuropsychologist at the Berman Brain & Spine Institute. “It will also allow us to further promote concussion awareness and prevention.”

Through the “Keeping Our Most Vulnerable Kids Safe Program,” health professionals at the CSCP will administer Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) to student-athletes. ImPACT is a computer-based self-test that measures brain processing speed, memory and visual motor skills, all of which have been shown to be affected when a person sustains a concussion. In a two-phased model, student-athletes are tested at the beginning of their respective sports seasons to obtain baseline readings of their cognitive abilities. Then, should one of those tested sustain a concussion or suspected concussion during the season, he or she is tested again, and test scores are compared; a decline in scores suggests that the student-athlete has had a concussion and that medical intervention should be sought. Test scores are also used to aid in diagnosis and treatment and to determine the best course of action for the affected child. In addition to testing, grant funds will be used to educate parents and coaches about this very important topic.

“This program is based on realized deficiencies across the country for better education and clinical management of concussions and to accelerate recovery from injury so that children can return to school and to competitive sports quickly in a way that promotes their optimal health,” added Kevin Crutchfield, M.D., director of the Comprehensive Sports Concussion Program.

To learn more about the Comprehensive Sports Concussion Program at LifeBridge Health, call 410-601-WELL or click here.

Sports-Related Concussions Pose Serious Risk

by Kevin E. Crutchfield, M.D., Director, Comprehensive Sports Concussion Program,
Sandra and Malcolm Berman Brain & Spine Institute

With the school sports season gearing up, remember that sports-related concussions are a risk for athletes.

Concussion is the most common type of traumatic brain injury, and repeated concussions can cause cumulative brain damage or severe complications, or second-impact syndrome. Someone who has sustained an initial brain injury and then sustains another before symptoms associated with the first have fully cleared is at risk for second-impact syndrome.

Concussion in school-aged athletes is an under-recognized health risk; those who experience concussion are at long-term risk of persistent health problems and diminished lifelong potential. Although 1 in 10 athletes reports suffering a concussion during the athletic season, we have no guidelines regarding when it is safe for the young athlete to return to competition. But hitting the field too early after an injury will place him or her at increased risk of permanent brain damage.

The severity of a concussive injury must be determined by an expert in the field of brain injury. At The Sandra and Malcolm Berman Brain & Spine Institute, an interdisciplinary team of health care professionals provides the clinical evaluation, neurologic and neuropsychologic evaluations, neuroimaging tests such as CT and MRI, and excellent care necessary to evaluate, diagnose, and treat head injury.

Look for a future post to discuss the signs and symptoms of brain injury.

To learn more, call 410-601-WELL and visit us at www.finallyanswers.com.