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Time-out urged for athletes after blows to head

The Los Angeles Times

In an attempt to set a new standard for how amateur sports leagues treat brain injury, the American Academy of Neurology recommended Monday that any athlete suspected of suffering a concussion be removed from play immediately and be seen by a physician specially trained in the evaluation and treatment of brain trauma. Athletes should not return to play, the group said, until they have been cleared by a specialist.

The nation’s largest professional association of neurologists also recommended that certified athletic trainers be present at all sporting events — including practices — at which athletes are at risk of concussion.

The position statement, published yesterday in the journal Neurology, was issued two weeks after the National Football League announced tough sanctions against the helmet-to-helmet tackles thought to carry the highest risk of brain injury.

The statement is likely to have its greatest effect on the 4.1 million players in high school and youth football leagues, whose practice sessions and games are rarely monitored by professionals trained to detect and treat brain trauma.

The Western Pennsylvania Interscholastic Athletic League instructs its 126 football-playing schools to abide by the sports medicine section of the Pennsylvania Interscholastic Athletic Association handbook, which states that an athlete diagnosed with a concussion “should not be allowed to return to play on the day of the injury.”

It further states, “No athlete should return to play until cleared by a licensed physician of medicine or osteopathic medicine (MD or DO) comfortable with current concussion management principles.”

There are 135 schools playing football in the WPIAL and City League, with an estimated 6,000 student-athletes.

The explosion in youth sports in recent decades has put elementary and middle-school athletes at growing risk for concussion. The number of children seeking emergency care for sports-related concussions more than doubled from 2000 to 2005, according to a study last summer in the journal Pediatrics. That increase was driven largely by a surge in such injuries among children 8 to 14.

Those numbers are a source of rising concern, experts say, because research suggests that young brains are more vulnerable to a concussion’s effects and take longer to heal. The increasingly competitive culture of youth sports, paired with scant expert oversight, suggests that many young athletes are not removed from play quickly enough or long enough to protect their developing brains.

“Our mantra is ‘when in doubt, sit them out,’ ” said Christopher Giza, a UCLA pediatric neurologist who helped draft the position statement. “We should be erring on the side of getting them out of a situation where they could be at risk of additional injury.”

Professional sports and college athletic programs typically have trainers and sports-medicine specialists at games and practices. Following new guidelines adopted by the National Federation of State High School Associations, high school programs this fall began removing athletes suspected of having concussions from play and allowing them to return only after they had been cleared by “an appropriate health-care professional.”

By contrast, youth leagues generally rely on volunteers and parents to judge whether and how long an athlete should be removed from play. That can be a disaster, said youth sports safety activist Brooke DeLench, because coaches often are untrained and many parents fail to recognize or respond to concussion symptoms such as slurred speech, memory problems or disorientation.

DeLench cited a survey released last summer that found parents of children who participated in sports were woefully uninformed about the symptoms of concussion.

“I think everyone’s playing catch-up, including the American Academy of Neurology,” said DeLench, who founded MomsTeam after a neurologist urged her to remove one of her three sons from collision sports after his third sports-related concussion in 2000.

The American Academy of Neurology last issued practice guidelines on concussion in 1997. Since then, concussion research has exploded, fueled by activism among professional athletes and the U.S. military’s need to address brain injuries among combat veterans from Iraq and Afghanistan.

Brain trauma is more difficult to characterize, care for or recover from than experts had long believed, and as a result, the 1997 guidelines are “out of date,” said Jeffrey Kutcher, director of the University of Michigan’s Neurosport Program and lead author of the academy’s statement. Kutcher and 11 other brain injury experts are rewriting those guidelines for an expected release in April 2012.


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