Much attention has been given to professional sports and concussions lately, and seemingly for good reason. Concussions are the most common type of brain injury and most often caused by a sudden blow to the head, which in turn can cause the brain to shake inside the skull. Though permanent brain damage is rare, a concussion stops brain activity during the injury.
Trinity Health has recently made an investment in their sports medicine department by purchasing iPads with special Injury Zone software for trainers. The software just added a concussion app that trainers can use when an athlete becomes injured, which enables the trainer to do a quick concussion assessment. Robyn Gust, sports medicine coordinator with Trinity Health, said Injury Zone is an electronic medical record they use in sports medicine and is different from the records used in hospitals because it's on a sports setting.
"This will give availability to immediately test an athlete for concussion using SCAT-2 (a standardized concussion assessment tool), and will allow us to test the athlete every day and have information to compare it to," Gust said. Before using the concussion app, trainers just relied on what the athlete would tell them, she continued. Now training staffers will have all of the medical information on file with the app, so they'll know how many injuries the athlete has had, Gust said. Plus, the iPads will make the information available on the athletic field, which they haven't been able to do before. The concussion app will help the trainers be more consistent in evaluating and assessing the recovery in an athlete who has had a concussion, Gust added.
Cassandra Heald, graduate assistant athletic trainer at Minot State University, sitting, and Robyn Gust, sports medicine coordinator with Trinity Health, demonstrate how the concussion assessment works.
"A lot of us had been playing with the (concussion) app on our smartphones, but the screen was too small," Gust said. "The iPad is better than anything we've had in the past."
The trainers have been using the concussion app at athletic events since they received the iPads the first week in December.
"Concussions have been important to us for a long time and we want to keep up to date on the latest practices and managements," Gust said. The investment of the iPads was as no-brainer, she added, and didn't take much convincing from anyone.
"We see so many kids in so many areas and we need to do (assessments) in a quick and timely fashion," Gust continued. There are other attachments to Injury Zone coming out soon, so the concussion app is just the beginning, she said.
A concussion assessment starts at the time of injury, Gust explained. The trainer will determine if the athlete is aware of his or her surroundings and trainers always assess neck injuries in cases of head injuries, she said.
"It's very intense because it's quite a barrage of questions when assessing and will probably take 15 minutes minimum," she said. "Any sign or symptom of concussion in a high school athlete, state law says they're done - no questions asked."
Before the concussion app on the new iPads, the trainers assessed concussion in much the same way, but it took longer, Gust said.
"Now we just hand the athlete the iPad and they answer the questions," about how they're feeling at the time, she continued. Trainers can compare past assessments with the current one because the assessments are stacked on top of one another. In turn, that makes for a standard assessment, because the athlete has to answer the questions that the app provides. Trainers can also print off a page of the assessment for the coach or doctor.
"All of the athlete's health information is on the page, though, so we have to be protective of it," she said.
Concussions are fairly common in all sports, Gust said. Education and awareness is on the rise, however, and there's a better recognition for what concussion injury is.
"It used to be an accepted practice to just shake your head and go back on the field," she said. There isn't as much resistance to concussions as there used to be, though.
Getting hit in the head or taking a body hit are causes of concussion, Gust said.
"The brain will move anytime the body takes a blow," she noted. "Whenever there's a blow, the brain will smack into the skull. The brain is like a pickle in a jar. There's not a helmet out there that will stop the brain from moving."
Treatment for concussions involves rest and decrease in brain activity, Gust said, like backing off from playing video games and texting. Mainly, treatment involves waiting it out.
"It's frustrating for athletes because they look fine," she noted. "We wait until the symptoms completely go away and then the athlete is allowed 20 minutes of play (in the game)."
The athlete has to show no symptoms for 24 hours, she added, and a little more activity is introduced each day. If the athlete displays any symptoms while playing, though, Gust said he or she starts back at square one.
"We just have to be patient, but we can't waver on how we treat it," she said. "We have to make sure they stay safe."
The time for treatment can vary anywhere from five days, which is rare, to months until the athlete is back to full play, she continued.
There is no way to prevent concussion, Gust said, but technique is important, like making sure to tackle with the head up. Good equipment will possibly help a little, too, she added.
The most difficult part in assessing a concussion is trusting that an athlete is telling the truth, because the athlete just wants to play in the game, Gust said.
"So the software is good because they can answer the questions on it," she noted.
What's more, Gust didn't think the athlete would remember how they rated their symptoms from one day to the next. The trainer also conducts frequent physical tests like balance and coordination as well as the athlete's ability to memorize five words and a series of numbers, and that makes it harder for the athlete to lie.
It's hard to tell the athlete that they can't practice or play their sport, Gust said.
"It's like taking a tiger out of the jungle," she said. "You have to be careful not to send the athlete into a mental depression. We don't make any friends when dealing with concussion."
Treating a concussion early is important and the person could die if the concussion isn't treated, Gust said. If someone receives a second concussion before the first one is healed, then you can end up in a vegetative state or die, she added. "The consequences are well beyond the reasons to keep playing."