By Paula Roberts
Lincoln Academy athletic trainer Megan DeRaps tapes Brianna Genthner’s ankle. |
The long term effects of multiple concussions came roaring back to the forefront earlier in March when San Francisco 49 rookie Chris Borland announced he was retiring after just one season in the NFL. The reason, he was worried about long term cumulative effects of concussion.
In Maine, Doctors Paul Berkner, Joseph Atkins, and William Heinz brought concussions to the forefront when they started the Maine Concussion Management Initiative, or MCMI, based out of Colby College in 2009.
Seventy-five athletic trainers from Maine attended the initiative’s kick-off conference that year. MCMI subsequently established a baseline screening procedure for Maine high school athletes, which included over 6,000 kids.
According to their web page, “Maine Concussion Management Initiative (MCMI) is dedicated to improving the safety of Maine’s youth by increasing awareness and education on concussion management.”
Currently MCMI is collaborating with the Harvard Medical School, Boston Children’s and Spaulding Rehabilitation hospitals on groundbreaking new concussion research.
According to the website, more than 100,000 young men and women in the United States suffer new sports related concussions each year in the United States.
The Center for Disease Control reports that in the last decade, emergency department visits for sports related concussions in children and adolescents have increased by 60 percent.
“Even the mildest head trauma can have lasting effects – especially if it occurs during the formative high school years. The lack of proper management and diagnosis can lead to serious problems, including depression, impaired memory and thinking skills, more head traumas, and even death,” the MCMI website states.
In March of 2011, Sen. Brian D. Langley, R-Ellsworth, and Rep. David E. Richardson, R-Carmel sponsored L.D. 98, Maine’s concussion policy bill. The bill was designed to direct the Department of Education to adopt a policy regarding management of head injuries in youth sports.
L.D. 98 passed and was signed into law by Gov. Paul LePage on May 21, 2012.
Soon after, the Maine Department of Education adopted a management of concussion and other head injuries policy.
LA concussion management
Lincoln Academy athletic director K.J. Anastasio said the Newcastle high school began utilizing the new requirements when they came out several years ago. Anastasio said the new policy was “a step in the right direction.”
“The only issue LA had at that time was we didn’t have an athletic trainer on staff to assess the athlete,” Anastasio said. “That meant that any time there were any symptoms, even if they lasted a few seconds, by law, they had to see the doctor, even if we thought they hadn’t sustained a concussion, before they could return to play.”
More recently, the school has added athletic trainer, Megan DeRaps of Coastal Orthopedics. According to Anastasio DeRaps is able to provide immediate, on site evaluation.
“If concussed, the student athlete receives proper treatment immediately, and if not concussed, Megan can allow them to go back to competition,” Anastasio said. “In addition to the state law, we utilize a five day progression to participation process which Megan oversees.The athlete still must be cleared by a concussion management specialist before they can return to competition. Having Megan and these added steps is a safeguard that protects our student athletes greatly.”
In her first two season at LA, DeRaps dealt with six concussions in the fall and three during the winter season. She, like most athletic trainers in the state, received her concussion training through MCMI.
Years ago there used to be a grading system for concussions. “They have done away with the grading system. You either have a concussion or you do not,” DeRaps said.
At Lincoln Academy, if an athlete receives a concussion, the athlete has to be cleared by two people in order to return to play. One of them is the athletic trainer, and the other is a doctor with concussion training.
Lincoln Academy is fortunate to have had nurse practitioner Melody Saux in house, who has been trained as a concussion specialist and can clear athletes to play as well.
The goal of the five day progression is to avoid second impact syndrome, which is a second concussion before the first concussion has healed.
“It can be fatal,” DeRaps said. “Word is getting out there.” Long gone are the days where a “coach tells a kid you got your bell rung a little bit, you’re OK, get back out there.”
Of the nine concussions DeRaps has handled at Lincoln Academy, three of them were not the athlete’s first concussion. One athlete she works with has received four diagnosed concussions.
“We had the conversation,” DeRaps said. “Maybe you need to consider not competing in contact sports. My limit is around four concussions, if they are really bad ones, maybe three. It depends on the healing time, did the concussions heal in under two weeks, or two months. If the concussion took two months to heal, my limit is three. If you have a history of multiple concussions, a year later is better than back to back, but it is still more damage to the brain, ” DeRaps added.
“Concussion information is so new it is hard for people to grasp it. I tell them this is your brain. We need to care for it. You need your brain to function. The hardest part is to get them to realize that,” DeRaps said.
Having a concussion is an excused absence at Lincoln Academy.
Before an athlete can begin the five day return to play progression, they must return to school and be symptom free for one day.
On day one of the progression, an athlete must be able to ride a stationary bike for 20 minutes with no symptoms. If they pass, they advance to day two, 24 hours later, and must run on a treadmill for 20 minutes with no symptoms.
On day three they can participate in a non-contact practice; day four participate in contact practice, and day five they can compete in a game. If an athlete has any symptoms during the progression, they repeat that step until they are symptom free.
The process is “six days minimum,” DeRaps said. “Each concussion is individual. Concussions still are dangerous if not handled properly. That’s where an athletic trainer comes into play. My job is to keep the kids safe.”
