High School Starts Concussion Screening Program–November 25, 2009
By Paula Antonevich/Special to the Lexington Minuteman

Sports-related concussions have always been part of contact sports - and in turn, a concern for athletes, coaches, and sports programs. In recent years, the issue has received increased attention, particularly the long-term effects on athletes returning to the playing field after suffering multiple concussions.

While most discussion has focused on college-level and professional sports, including recent hearings on Capitol Hill, concussions are a serious concern for the athletic staff of high school sports programs, including Lexington High School (LHS).

The heightened awareness of concussion risk and the increased need for the concussion screening at LHS led to a new program for 2009-10, "Concussion Screening Program for the Lexington High School for Student-Athletes," funded by the Lexington Education Foundation (LEF).

The grant was awarded to the LHS Athletic Program, with Eamonn Sheehan, coordinator of physical education and wellness and head athletic trainer, as the project director.

How it works
Before the start of every sports season, LHS student-athletes take a 30-minute screening test, the "imPACT Testing System," that measures multiple aspects of cognitive function. This initial test then serves as a baseline measurement for each student. The baseline test is valid for all three sports seasons over a two-year period.

Should a student sustain a concussion during athletic competition, he or she will retake the test and will be held from practice or play until the test results return to the baseline level.

Sheehan said that there are additional safeguards before returning a previously concussed student to play including physician clearance, the need to pass an exertion test, and a managed plan to return to the team, implemented with the coaching staff's support.

Approximately 500 to 600 LHS students participate in school-sponsored sports programs annually at the varsity, junior varsity, and freshmen level. Head injury from impact or whiplash can occur during practice, scrimmage, and game situations.

What is a concussion?
According to the American Academy of Pediatrics, a concussion is a type of mild traumatic brain injury caused by an impact or jolt to the head; with proper management, most children and adolescents sustaining a sport-related concussion can expect to recover fully.

However, it is widely documented that students who have suffered a single concussion and are returned to play too soon are more susceptible to subsequent concussions, which can have serious long-term effects. Some students experience lasting effects that affect not just their athletic participation but their academics as well.

Back to the field
To avoid repeated concussions that may have cumulative effects, determining when an athlete can safely return to play is crucial. LEF Board member, Jim DeVellis, MD, an orthopedic surgeon and team physician for Bentley University and many of the high schools in the Middlesex league, said "there is a significant need for objective concussion data." Having baseline and concussion screening test results available "provides the information necessary to assist in reaching a more educated, objective return-to-play decision," he said.

Before they had the baseline screening test, LHS athletic staff relied on "less- reliable reproducible data." This included, for example, observation and student self-reporting of symptoms to help assess student's eligibility to return to play.

Since the beginning of the school year, Sheehan estimates that approximately 500 student-athletes have been baseline tested.

This fall, more than 20 student-athletes have suffered a concussion. Due in part to the information provided with imPACT re-tests, students were prevented from returning to the field for practice or games until they had sufficiently recovered, and in some cases were kept out longer than they would have been without the baseline test as a reference point.

LHS Athletic Director Naomi Martin is supportive of the new concussion screening program.

"For LHS, it is not just a tool to get the student athlete ready for the next game, it's about making sure they are not suffering long-term ramifications from a high school head injury, "she said. "We have an obligation to help the student- athletes look further than their high school moments and get them ready for productive, healthy lives."

Program impacts
Evaluation of the pilot concussion screening program will be ongoing throughout the year, and "We hope this becomes a permanent part of the sports program in Lexington," says Elisabeth Donahue, LEF Co-President.
The imPACT assessment program accomplishes four things.

--It will allow the athletic training staff and coaches to accurately test and assess every LHS student-athlete playing an impact sport.

--It will provide a clear protocol for using the test and subsequent assessments.

--It will enable the athletic staff to work more effectively with student health services and the guidance office when a student suffers a concussion.

--It will improve the overall health and safety of student-athletes at LHS.
Concussion screening programs are not mandatory for public schools, but a more supportive system is now in place for LHS student-athletes.

Since its inception, LEF has awarded more than $2.9 million to Lexington educators through its competitive grants program. For more information about LEF, the Concussion Screening Program, or a full listing of awarded grants, please visit the LEF website at www.lexedfoundation.org.