Brookline High: Prioritizing Player Safety and Concussion Management

National Football League commissioner Roger Goodell announced on Oct. 18 that the NFL, in an effort to curb the large number of in-game concussions players were suffering, would take a stronger stance against helmet-to-helmet hits. The next day, three players were fined $175,000 for hits in their most recent games.

Some NFL players criticized Goodell’s decision, but brain-trauma researchers praised the move as the NFL’s first acknowledgment of the serious dangers posed by concussions.

Prior to this acknowledgment, the NFL had repeatedly denied any association between concussions suffered in play and the emotional and behavioral problems that many ex-football players reportedly suffered from. But at the high school level, schools such as Brookline High School in Massachusetts have long since accepted the dangers of concussions, and they’ve instituted comprehensive programs to properly diagnose them and manage recovery.

“We can’t stop them,” says Brookline High’s athletic director, Pete Rittenburg. “The critical thing is making sure that they’re recognized, and not letting someone return to play too soon.”

To improve concussion recognition and management, Brookline High works with Dr. Neal McGrath, a neuropsychologist whose organization, Sports Concussion New England, is based in Brookline.

McGrath says the partnership with Brookline High began during the 2004-2005 school year, a year after McGrath’s son suffered a concussion while playing football for the Brookline Warriors.

“To my knowledge, there was no school that had a comprehensive concussion management program going,” McGrath says, and he sought to create one at Brookline High. After the program’s pilot year, Rittenburg took over as athletic director.

“We sat down with him and met with him to explain what had been developed and what was available, and Pete, coming fresh into the job, was right on it,” McGrath says. “He sought the funding for it, and he’s made sure that it’s remained a priority in the Brookline athletic department.”

McGrath defines a concussion as a “mild traumatic brain injury,” and “a disturbance in brain function that is caused by a traumatic blow to the head.” McGrath says that a body blow that results in whiplash can also cause a concussion.

McGrath says that concussions usually result in a combination of symptoms that fall into one of four categories:

• Physical, including headaches, dizziness and blurred vision;

• Mental or cognitive, including memory loss and attention lapses;

• Sleep-related, including trouble falling or staying asleep and fatigue; and

• Emotional, including feelings of anxiety, depression or irritability

While physical, emotional and sleep-related symptoms are tracked using clinical evaluations and interviews, McGrath says that cognitive impairment is far more difficult to track. In order to help its trainers and team physician determine when a student-athlete’s cognitive abilities have returned to normal, Brookline High uses the Immediate Post-Concussion Assessment and Cognitive Testing, or ImPACT, program.

ImPACT tests memory and reaction time through a series of computer-based tests in which the athlete is shown a series of words or designs. The athlete must then decide if a certain word or design was in the previously shown sequence or not.

Rittenburg says that all athletes playing “collision” sports – which include football, soccer, field hockey, basketball, lacrosse, gymnastics, diving, rugby, baseball, and softball – are tested before the season begins to determine baseline cognitive levels.

Alex Jzyk, Brookline High Schools’ athletic trainer, says that approximately 1,000 student-athletes play for Brookline High each year, many playing multiple sports. When a player suffers a concussion, Jzyk says, that player will usually take the ImPACT test at least three times before being cleared to play: between 24 and 72 hours after the injury, once the athlete is symptom-free, and once after exercise.

“We manage this very well,” Jzyk says. “We do it for the right reasons.”

McGrath says he focuses his work on high school athletes because there are more high school athletes than college or professional athletes, but they’re already playing with bodies strong and fast enough to cause concussions after a collision.

McGrath also stresses concussion management at the high school level because of second-impact syndrome, a condition where the brain suffers a second injury before fully recovering from the first. This causes massive swelling in the brain that can lead to permanent impairment and often – McGrath says it’s as high as 50 percent – death.

In the Fall 2007 issue of SportingKid Magazine, the National Alliance for Youth Sports said that second-impact syndrome is found almost exclusively in athletes under 18 years old.

Rittenburg and Jzyk have made sure that athletes who suffer concussions are given as much time as they need to heal. Rittenburg says that not only are athletes kept off the field until they’re symptom free, but Brookline High also excuses athletes from full academic workloads until they’re fully recovered. McGrath says pushing oneself mentally while in recovery is like running while still healing from a sprained ankle.

Brookline High pursues many avenues of educating parents on concussion care and management. McGrath has taught seminars for parents of athletes at the school. The athletic department’s website links to McGrath’s website and features a “Concussion Home Care Sheet,” designed by McGrath and Rittenburg. And, starting with the spring 2011 season, athletes will be given a packet of information to take home.

Brookline High may have been the pilot school for this organized concussion management program, but it is no longer the only one. Sports Concussion New England lists 34 youth sport programs, high schools and colleges as partners on their website. These partners include Franklin High School, the 2010 Massachusetts boys’ soccer champion, and Brookline-Jamaica Plain Pop Warner football, whose D Red Team was the 2010 state champion.

Jzyk says that Brookline High’s athletic program may not produce as many championships as other schools and programs, but their commitment to player safety is strong.

Says Jzyk, “Their safety is more important than a winning season.”

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