Concussion law brings awareness to forefront

Alex Saunders' football career at Cedar Rapids Jefferson ended because of it. Linn-Mar senior Mark Atwater's experience led to different equipment. Both demonstrate the effects of concussions in sports.

When players take the field Friday night for the first week of statewide football competition, they, and their parents, have been informed on concussions, including prevention, symptoms, signs, appropriate care and the procedures for the athlete to safely return after being diagnosed with one thanks to the steps of the Iowa Legislature.

Lawmakers passed the bill in April, mandating prep athletes in grades 7-12 and their parents sign a fact sheet prior to participation, a player must be removed if a coach or official observes signs, symptoms or behaviors associated with suffering a concussion (a brain injury caused by a bump, blow or jolt to the head or body), and that a player will not be allowed to return to participating - in games or practice - until receiving a sign release from a licensed health care provider. The measure applies to both male and female sports and "extracurricular interscholastic activity" which includes dance and cheerleading.

Carlton Saunders, alex's dad, would like to see even more steps taken. He would like to see informational meetings with medical experts held instead of a fact sheet that can easily be discarded or ignored. He knows that would mean more time, but said when your child's long-term health is at stake it is worth it.

"Make it part of the process," Carlton Saunders said. "Knowledge is power."

Saunders was a volunteer coach at Jefferson when his son, a senior and standout basketball player for the J-Hawks, played varsity football. Saunders' prep football career was cut short last year when he suffered two concussions in a 12-month period.

"Having two in 12 months was enough," Carlton Saunders said. "We did stop him."

Saunders suffered a concussion in football practice as a sophomore, missing three games. The second trauma, which Carlton Saunders said was diagnosed as a Grade 3 concussion, caused him to miss the final four games last fall.

After the first head injury, Saunders had difficulty at school, receiving headaches caused by sensitivity to brightness. The family was able to recognize the problem.

"We were fortunate enough and fortunate enough to know there were issues with the first one because of the light sensitivity that was key for him," said Carlton Saunders, who said his family met with doctors immediately after the second injury and they called to end to his participation in 2010. "The Grade 3 concussion was even worse."

Atwater endured a concussion while playing as a freshman. It motivated him and his family to start using an advanced Xenith helmet his sophomore season. He hasn't had further problems.

"It's a serious matter," said Atwater, whose dad, Larry, is an assistant football coach and former head wrestling coach at Coe. "I've talked about it with my parents alot. ... They're pretty concerned about that and want to make sure my health is in my best interest. They've done a lot as parents to make sure I feel well."

Athletes can't afford competing with fears of getting hurt, because it can often lead to serious injury. Whether its going for a tackle, attempting to take head a free ball in soccer or returning a wrestler to the mat or shooting a takedown, prep athletes are focused on the play and not the consequences.

"No one ever thinks there is a possibility I could get a concussion tonight or possibly get hurt," Atwater said. "That never crosses your mind. You just fly around and do it. It's part of the game."

The law is a step in the right direction, but adhering to it is the only way it will take effect. Atwater hinted that some players, despite the warnings, will still try to avoid being removed from games. He has heard stories from his dad's players about creating diversions to hide a possible concussion.

"It's a good idea for everybody to know about it, but it's how you act upon it," Atwater said. "There's going to be hundreds of high school athletes that their head hurts, they don't feel good, but they're going to say they feel fine. Until that ends then the big problems with concussions aren't going to end, because you can read the sheet and understand it, but kids get going and the competitiveness gets to you and you just don't want to come out."

According to Dr. George Phillips, an Associate Program Director of Pediatric Residency Education and Clinical Associate Professor of General Pediatrics and Adolescent Medicine at the University of Iowa, said Iowa is the 19th state to sign legislation in place, regarding athletic head injuries. During a concussion and safety seminar at Iowa City in July, Phillips said 28 other states have a imilar statute and 15 more had pending bills.

"It really has been a rapid swing the last two years and I think it's the first steps in really bringing concussion to the forefront as a commonly accepted injury," said Phillips, admitting club and youth sports are harder to regulate but hopes they adhere to the spirit of this law. "One that we talk about just as much as ACL tears, rotator cuff tears or Tommy John surgery, and then really becomes part of the standard sports parlance."

Watch video from medical experts during the concussion seminar at UI in July.

Similar bills have been inspired by Washington state's Lystedt Law, named after Zackery Lystedt, a football player severely injured during a game in 2006. The 13-year-old Lystedt was playing middle school football when he hit his head on the ground during a first-half play and rose in obvious pain. He sat on the sidelines for 15 minutes before re-entering. He made a goal-line play in the second half, causing a brain hemorrhage. The injury is an example of second-impact syndrome. 

"The history in the U.S. is it often takes a tragedy to move us forward," said Phillips, citing the Lystedt case. "it was a really tragic event, but the great thing to see, like many public health issues, that comes to the forefront. States can often craft great pieces of legislation that really support public health."

According to the Center for Disease Control, 135,000 sports- and recreation-related brain injuries in youths from 5 to 18 are treated by emergency departments across the nation. Sports-related concussions are balanced between male and female when football is not factored in the equation, according to Dr. Andy Peterson, a Clinical Associate Professor of Pediatrics at the UI. Football makes an overwhelming difference.

"American football is in a league of its own," Peterson said. "There's pretty good evidence there's a higher risk for concussions in American football. Higher than amateur boxing even. Even in a sport where the goal is to hit someone in the head as often as you can, American football seems to have a higher rate of concussion."

Testing has advanced. Athletic trainers are well verse in various diagnostic tests, including Immediate Postconcussion Assessment and Cognitive Testing (ImPACT) and Sport Concussion Assessment Tool (SCAT2). Those tools help medical professionals assess post-injury recovery. ImPACT uses various memory and matching exams. SCAT2 evaluates symptoms, a cognitive exam and balance and coordination tests.

"None of the stuff is fool proof," said Matt Doyle, Director of Athletic Training Outreach Program for UI Sports Medicine. "They're not infallible but each when pieced together give you a piece of information and make you feel better about the decisions you're making with a patient."

Properly fitting equipment, including mouthpieces, neck strengthening and form tackling have benefitted players. The legislation bolsters the effort made by coaches to help prevent head injury.

"I think you'd be hard-pressed to find a coach that doesn't talk about it," Cedar Rapids Kennedy Coach Tim Lewis said. "I think everybody's doing that and we have to because concussions aren't going to change so we have to do everything we can to prevent them.

"We coaches would be foolish if we don't do something and we're not constantly talking about it."

Peterson said some coaches express frustration that the new requirements will delay a player's return, but said a player can return quicker, avoiding prolonged effects by returning too soon. Terry Noonan, Director of UI Athletic Training Services, said an athlete needs anywhere between three to 10 days to regain a normal state following a concussion.

Sometimes the topic can be challenging, especially for a generation of players whose concussions were classified as "getting your bell rung" or "dinged up."

"You've got to remember that all of us that are coaching this game played in an era where we all probably had numerous concussions," Lewis said. "We just played through it."

The measures create another hoop for parents and athletes to jump through to participate. Parents and players have taken it in stride, and with recent attention given to concussions they aren't shocked about it.

"We really haven't had any reaction at all from the parents," Cedar Rapids Xavier Coach Duane Schulte said. "I think they are doing what they are told to do."

Even before the bill was signed into law the Iowa High School Athletic Association and Iowa Girls' High School Athletic Union instituted an initiative to inform athletes and their parents, coaches and officials about the issue of sports-related head injuries. Actually many of these steps were in place for the start of the 2010-11 school year.

IHSAA Assistant Executive Director Alan Beste noted the main difference with the law is now parents and athletes must sign the concussion fact sheet, have written clearance and the designation of which medical professionals can release a player.

"It puts the weight of state law behind what needs to happen," Beste said. "Their awareness is heightened because now it's state law."

Beste said former Maquoketa wrestling coach and District 13 State Senator Tod Bowman was a key advocate of the bill. He worked with the Brain Injury Association of Iowa to champion the legislation. The effort was backed by the IHSAA and IGHSAU.

"The impetus behind the whole thing is to keep kids safe," Beste said. "If the legislation helps keep kids more safe than the protocol was that we and the Girls Union implemented then we were all for it. We supported it the whole way."

New procedures seem to be more of an informative measure than a deterrent to playing hard and risking injury, helping parents and athletes identify and seek appropriate care when problems occur. If that is the spirit of recent legislation then it is working.

"If they're trying to make awareness part of it then that's certainly effective in that regard," Schulte said. "It brings everybody to the forefront if you actually have to sign a document stating you're aware of it."

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