Dec 5, 2016
Allied Approach

High schools around the country are searching for ways to address the danger of sports-related head injuries. A recent partnership in Marin County, Calif., may be paving the way for a new angle.

The collaboration involves Marin General Hospital, Kaiser Permanente Hospital, Marin County Board of Education, the Brain Injury Network, and the University of California, San Francisco working together to establish a policy for effectively preventing, reporting, and treating concussion among high school athletes in the county. One of the first steps was education and raising awareness around brain injuries.

“We are focused on education with the coaches, athletes, and parents so they understand concussions,” Kit Holsten, ATC, Athletic Trainer at Marin County’s Terra Linda High School and Tomales High School, told The San Rafael News Pointer. “We do have a lot of parents [bringing] children into the hospital after a concussion. We will work with pediatricians to make sure the children are taken care of.”

Getting athletic trainers and physicians on the same page was another priority for this partnership. Before, students who suffered a concussion often received conflicting information based on the athletic trainer or physician who diagnosed them. High schools in Marin County now hope to establish a comprehensive approach to treating concussions so that student-athletes are not cleared for activity before they are ready.

Part of making this a reality is having local hospitals provide all schools with access to athletic trainers at games to diagnose and treat head injuries right away. So far, three Marin County high schools have received athletic trainers from Marin General. In addition, several others are working with UCSF to ensure that athletic trainers are present on the sidelines during high-risk sports activities.

When an athlete does suffer a head injury, the partnership has created a return-to-play policy for all schools to follow. It starts at the beginning of each season. Student-athletes who play contact sports at Marin County public schools undergo baseline neurocognitive testing. This provides athletic trainers and doctors with an image of the student-athlete’s healthy brain function. If a player suffers a head injury later on, a follow-up test is conducted to determine any changes from the baseline test.

Another part of the collaboration requires student-athletes who have concussions to check in with their athletic trainers on a regular basis to track their recovery. Shana McKeever, MA, ATC, CSCS, Athletic Trainer for San Rafael High School, explained the steps for returning an athlete to competition.

“It is very strictly monitored,” she said. “It starts with light aerobic activity as part of an eight-stage progression. There is a 24-hour window between stages to monitor the student. We go from light activity to light resistance, then non-contact drills, then move to limited contact. The final stage before returning to play is full participation in practice. If at any time the symptoms persist, we will stop and evaluate the student’s condition.”

There is also an academic protocol in place to help students with a head injury transition back to a full load of schoolwork. Both the athletic and academic protocols are crucial to ensuring a proper recovery.

“Getting them back to school, we start with a partial day and work through classes, then they are allowed to leave after a half day,” said Holsten. “The student is monitored after the half day.

“During a full day at school, we want to know if [the concussed student-athletes] have a hard time concentrating or are more easily distracted,” she continued. “Does studying create headaches because they’re over thinking too much? It’s really frustrating for them. They want to do well, but they understand they are injured.”

A final piece of the partnership in Marin County is collecting data about concussions and impacts to the head. Last year, McKeever began using electronic sensors strapped under helmets to monitor San Rafael football players. The sensors record any head impacts sustained, and the data is then transmitted to a device on the sidelines. With San Rafael recently receiving a $5,000 community service grant from the Marin County Board of Supervisors, this program will expand next season to include soccer and lacrosse.

“We’re using impact sensors as a coaching guide,” McKeever said. “We can view, by team and athlete, the total number [of] hits, the three most recent hits, etc. We can see the hits in terms of G-forces and the rotational impact component.

“We also get notices about big hits,” she continued. “Anything over 15 Gs gets a notification. Anything over that threshold, and we pull the athlete off the field right away.”

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