Column: Concussions in Contact Sports

For the past two years, Winchester High School has mandated a baseline measurement of student athlete's neurocognitive abilities for all students participating in contact sports.

Using an internet-based screening tool called  "HeadMinder," student's recognition, recall, speed and accuracy is measured and an individual baseline determined during the preseason. During the subsequent athletic season, any athlete with a suspected concussion is required to take a follow-up trauma screening.

Jack Squeglia, retired Assistant Athletic Director at WHS, clarifies that "results are not used by the athletic department to determine whether a player can return to their sport after injury; that determination is made by the player's physician with the appropriate medical credentials." The Concussion Resolution Index (CRI) system, developed by Headminder, Inc., was funded by the Winchester Sports Foundation (WSF).  

Mark Robinson, WSF Board Member, was a driving force behind bringing the HeadMinder system to Winchester after his son was "knocked out" playing hockey in his junior year in an outside league game. 

"We exceeded what was considered the standard of care at the time and kept him off off the ice for five weeks, when three to four weeks was recommended," Robinson said. "But when he started playing again, his level of play was much lower. 'Sam doesn't seem right' was what his coach said at the time." 

Robinson's research of concussions was greatly aided by consultation with Dr. Robert Cantu, one of the nation's top sports concussion specialists and Chief of Neurosurgery Service and Director of Sports Medicine at Emerson Hospital in Concord, Massachusetts, co-director of the Neurologic Sports Injury Center at Boston's Brigham and Women's Hospital, and Medical Director of the National Center for Catastrophic Sports Injury Research in Chapel Hill, North Carolina.  (Read more: http://www.momsteam.com/team-of-experts/robert-cantu#ixzz0vHmPNvLq)

"We were shocked to learn that our son suffered from Post Concussion Syndrome," Robinson stated. "At the time of Sam's concussion, there was still a very unclear understanding of diagnosing a concussion, how to treat one and how to adequately make the determination of when it is safe to return to play.   

"Typically, a doctor would just say to stay away from contact for three to four weeks and you should be fine. That is probably true in 65 percent of concussions. But around 35 percent of concussions will have lingering effects. . . . Dr. Cantu indicated that a baseline measurement prior to the injury could have greatly improved his evaluation of Sam."

Working with the WHS Athletic Director, coaches and trainer, baseline evaluation systems were considered. While the Head Minder CRI test is not expensive to administer, it is very time consuming.

The 25-30 minute test is taken on a computer with an internet link. The test requires great concentration and focus with a minimum of distractions to be considered reliable. The student athlete responds to pictures, numbers, shapes and sequences. The test results are not provided at the end of the test, as the intention is to establish a personal baseline, not to compare results across students. 

Post injury changes from this established baseline would be considered relevant diagnostic data for trained medical professionals concerned about possible brain injury. The baseline screening for each athlete is repeated every two years.

Despite all of the protective equipment used in contact sports, athletes still get injured. Sometimes proof is necessary to establish athletic fitness.

Squelia commented, "A former WHS player was barred from playing college level lacrosse because of a concussion history.  The data provided by this system was used to establish that she was medically fit for collegiate athletics." 

Data from the system can be shared online between athletic and medical professionals.

Currently the program costs $1,000 for 500 student assessments per year. The WHS athletic department is   investigating whether establishing baseline results for middle school athletes would be practical. 

Dr. David M. Erlanger, Chief Executive Office of Headminder, states, "We know much less about younger kids. The adolescent brain is much more like an adult brain. At 13, 14, and 15 years old we can say with confidence that our data is responsible, ethical and useful."

While the vast majority of parents are appreciative of the information provided by the system, there does appear to be a cultural bias in how communities respond to this type of screening tool. 

"We don't sell a lot of systems in Texas," says Dr. Erlanger.  "It all depends on where a family is coming from . . . For some families the way to deal with a ding is to shake it off and 'man up.' However, there is a balance between being an alarmist and being irresponsible. You can understand the risk and work within the guidelines."

The HeadMinder system is used primarily in college and professional athletic organizations. Winchester is one of only approximately 100 public high schools in the nation to have a Headminder system. Contact sports at WHS include football, lacrosse, hockey, wrestling, basketball, soccer, field hockey, and volleyball.