Concussions have always been a part of physical contact sports, but with athletes becoming bigger and stronger, something has to be done to raise awareness of the severity of concussions and what can happen later down the road if athletes are not given the adequate amount of time to recover. The National Football League has already put regulations on how long a player has to stay out after receiving a concussion and has started fining athletes that deliberately use helmet-to-helmet contact on an opposing player; the National Collegiate Athletic Association has started neurological testing to track a concussed athlete’s progress and have revised the guidelines on not letting athletes return to play the same day and having mandatory check-ups; but high schools have very few regulations to follow. A concussion is the same whether it happens to a pro player or a high school player, so why do the professional players take precedence over high school athletes? Changes need to be made so all athletes are cared for.
**Key Words:** concussions, helmet-to-helmet contact, National Football League, National Collegiate Athletic Association, neurological testing
Owen Thomas, junior lineman for University of Pennsylvania, Andre Waters, former Philadelphia Eagles safety, Chris Henry, the Cincinnati Bengals wide receiver and Chris Beniot, a pro wrestler; these men have been successful athletes, but that all changed after receiving countless blows to the head. They, as well as many others, have been diagnosed with Chronic Traumatic Encephalopathy (CTE), which according to the Center for the Study of Traumatic Encephalopathy is a progressive degenerative disease of the brain found in athletes and others, with a history of repetitive concussions. The brain degeneration is associated with memory loss, confusion, impaired judgment, paranoia, impulse control problems, aggression, depression, and, eventually, progressive dementia (2). After death, these four athletes had tissue from their brain examined, where each had evidence of CTE.
Helmet-to-helmet hits are becoming more aggressive, take for example the hit that Kevin Everett experienced in 2007, or the hit that Josh Cribbs received from James Harrison, and the memorable hit of Eric LeGrand that left him paralyzed from the neck down. Because of this the National Football League (NFL) and the National Collegiate Athletic Association (NCAA) have recently implemented rules to protect players from injuries that occur through these hits, but what about the high school athletes? The University Interscholastic League (UIL), which is the governing body of high school athletics in Texas, has started to take steps in changing the policies and guidelines that are currently being followed, but that isn’t enough.
#### National Football League
The new guidelines for the NFL provide more specificity in making return-to-play decisions. The new statements advise that a player who suffers a concussion should not return to play or practice on the same day if he shows any signs or symptoms of a concussion that are outlined in the return-to-play statement. It continues to say the player shouldn’t return to play until they have had neurological and neuropsychological testing completed and have been cleared by both the team physician and an independent neurological consultant (1). It is also outlines that if an athlete has symptoms of loss of consciousness, confusion, gaps in memory, persistent dizziness, headache, nausea, vomiting or dizziness, or any other persistent signs or symptoms of concussions the athlete should be removed from all activities (1).
#### National Collegiate Athletic Association
According to the NCAA a concussion is a brain injury that may be caused by a blow to the head, face, neck, or elsewhere on the body with an “impulsive” force transmitted to the head (9). An athlete doesn’t have to lose consciousness after a concussion occurs, but there are two things that a coach and athlete need to watch for: a forceful blow to the head or body that results in rapid movement of the head, and any changes in the student-athlete’s behavior, thinking or physical functioning. Some of the signs and symptoms that have been observed by both the coaching staff and student athletes consist of the student-athlete appearing dazed and confused, forgetting plays and being confused about assignments, while they have a headache, feel nauseated, confused, and are sensitive to light and noise (9).
After meeting, the NCAA committee that is responsible for recommending rules and policies made revisions on the previous guidelines found in the NCAA Medicine Handbook that all sports followed on concussion management. These revisions emphasize not letting a student-athlete return play the same day after a long duration of significant symptoms, and if the symptoms continue the athlete should not participate until cleared by a physician (3).
The NCAA wants all coaching staff and student-athletes to have full awareness of the severity of concussions, in doing so they have produced fact sheets for both, which recommend that athletes not hide it and that they tell the athletic trainer or coach so they can receive the proper treatment, and take time to recover. Just like every other injury, a concussion needs time to heal, and repeated concussions can cause permanent brain damage, and even death (9).
For Tarleton State University, located in Stephenville, Texas, neuropsychological testing is being done using ImPACT, which measures athlete’s attention span, working memory, sustained and selective attention time, response variability, non-verbal solving, and reaction time. ImPACT also provides computerized neurocognitive assessment tools and services that are used by coaches, athletic trainers, doctors, and other health professionals to assist them in determining if an athlete is able to return to play after suffering a concussion (6). Athletes start out taking the test to set a base line, they are asked demographic information and health history, what their current symptoms are, then take the neuropsychological test, which measures athlete’s attention span, working memory, sustained and selective attention time, response variability, non-verbal solving, and reaction time with six different modules that are labeled as Word Memory, Design Memory, X’s and O’s, Symbol Matching, Color Matching, and Three Letter Memory, they then get the injury report, and the ImPACT test scores (6). ImPACT is being used by the U.S. Army, professional teams, sports medicine centers, neuropsychology clinics, doctors, colleges, high schools, and club teams all across the United States, as well as Canada and Internationally. Tarleton State University has also required full participation of their athletes by informing them of concussions and having them sign an injury acknowledgement form, stating that they will be an active participant in their own healthcare. Tarleton has also stepped up in making the academic department aware of the severity of a concussion by producing information sheets that state the signs and symptoms, how a person recovers, and what a person with a concussion should and shouldn’t do.
#### High School
According to USA Today only Texas, Oregon, and Washington have enacted laws, all since 2007, to meaningfully tackle the issue. Oregon and Texas require athletes to be removed from play the day of the injury, while Washington gives coaches responsibility for removal (12). But still the UIL leaves it open for an athlete to return to play in the same day, if the athlete hasn’t lost consciousness and concussion symptoms are resolved within 15 minutes; and like its heat guidelines, concussion protocol is merely a set of recommendations and isn’t enforced. According to the Dallas News, fifty-three percent of public schools in Texas and about ninety-three percent of private schools don’t have a full-time certified trainer on staff, and thirty-three percent of public school and eighty-seven percent of private schools don’t have weekly access to a certified trainer (4).
The awareness of concussions has started to make its way to the top, according to the Fort Worth Star-Telegram the UIL and state education commissioners are currently working on approving that “Texas public high school athletes who get a concussion wouldn’t return to play until the next day, at the earliest, and a licensed healthcare professional would have to approve any return to play (7).”
With the number of athletes in public and private schools in Texas, and all across the United States, why has the issue of concussions not been dealt with before now? For fear of losing playing time there are fewer occurrences reports, but the long-term effects need to be stressed to all student-athletes. Not only athletes, but coaches, athletic trainers and parents need to be informed of the side effects that can happen if a concussion is not reported. Making it mandatory to do testing through concussion-based programs, like ImPACT, could be the first step in raising awareness and helping to give the adequate amount of time to recovery for those athletes who are injured.
### Applications in Sports
Everyone involved in contact sports, including coaches, athletic trainers, athletes, and parents, needs to know the severity of concussions. Many studies have shown what can happen if athletes don’t receive the adequate amount of time to heal after receiving a concussion, but compared to professional athletes there is little that is being done at the high school level to help with these recovery periods. Parents want to make sure their child is being cared for, while coaches have guidelines to follow to make sure their athletes makes a complete recovery, so following the footsteps of professionals and updating concussions guidelines can help in making sure everyone is taking the appropriate steps when a high school athlete has received a concussion.
I would like to thank Dr. Kayla Peak, the Director of the Graduate Program at Tarleton State University, for assisting in the development of this article.
1. (2010). NFL issues stricter guidelines for returning to play following concussion. E-Journal of The Sports Digest. Retrieved from http://www.thesportdigest.com/
2. Center for the Study of Traumatic Encephalopathy, About CTE. (n.d.) What is CTE. Retrieved from http://www.bu.edu/cste/
3. Copeland, Jack. (2009). Safeguard committee acts on concussion-management measures. Retrieved from National Collegiate Athletic Association website: http://www.ncaa.org
4. George, Brandon. (2010, August 1). Hidden dangers: concussions in high school sports. The Dallas Morning News. Retrieved from http://www.dallasnews.com/sharedcontent/dws/spt/stories
5. George, Brandon. (2010, August 2). Texas’ UIL falls behind on concussion policy. The Dallas Morning News. Retrieved from http://www.dallasnews.com/sharedcontent/dws/spt/stories
6. ImPACT-Testing and Computerized Neurocognitive Assessment Tools, About ImPACT. (n.d.) Overview and Features of the ImPACT Test. Retrieved from http://impacttest.com/
7. McCrea, Michael, Hammeke, Thomas, Olsen, Gary, Leo, Peter, & Guskiewicz, Kevin. (2004).Unreported concussions in high school football players. The Clinical Journal of Sports Medicine, (14)1, 13-17. Retrieved from http://journals.lwwlcom/cjsportsmed
8. NCAA, Student-Athlete Experience, Student-Athlete Well-being, Concussions. (n.d.). 23 Sports Specific Poster. Retrieved from http://www.ncaa/org
9. NCAA, Student-Athlete Experience, Student-Athlete Well-being, Concussions. (n.d.). Fact Sheet for Coaches. Retrieved from http://www.ncaa.org
10. NCAA. Student-Athlete Experience, Student-Athlete Well-being, Concussions. (n.d.). Fact Sheet for Student-Athletes. Retrieved from http://www.ncaa.org
11. Schwarz, Alan. (2010, September 13). Suicide reveals signs of a disease seen in the N.F.L. The New York Times. Retrieved from http://nytimes.com
12. Tumulty, Brian. (2010, May 20). Study highlights frequency of concussions in high school athletes. Retrieved from http:// www.usatoday.com
### Corresponding Author
445 Oak Springs Drive
Seguin, Texas 78155
### Author Bio
Lindsey Neumann is a graduate student studying Kinesiology at Tarleton State University in Stephenville, Texas.