Jill Schramm/MDN Pediatrician Koyejo Oyerinde and physical therapist Reed Argent pause in an exam room at the CHS St. Alexius Health medical plaza March 29.

Physical therapist Reed Argent recalls his high school football team keeping smelling salts on the sidelines just in case a player was hit hard.

“They certainly don’t carry these in any sports medicine bag now,” Argent said of the heightened attention to the dangers of concussion in recent years. “Now we are maybe overly safe, but that’s better.”

It’s not just youth sports where concussions are being taken seriously. Head injuries and their repercussions have the attention of sports organizations at all levels as well as medical professionals who deal with people who have suffered accidental injuries.

Wahpeton native and former North Dakota State University stand-out Ryan Smith recently announced his retirement after three years in the Canadian Football League, citing concerns about hits that add up and the dangers of accumulated head injury. Former Minnesota Twins player Justin Morneau suffered a concussion during a collision at second base in July 2010. The injury was one of a series of head injuries, and while he eventually got back into the game, he’s stated the effects will always be with him.

The American academies of medicine, family medicine and sports medicine all have supported new care guidelines for concussions, said Dr. Koyejo Oyerinde, pediatrician with CHI St. Alexius Health in Minot.

“There’s a lot we still don’t know about concussions,” Oyerinde said. “We are better informed than in the past, but we still don’t know a lot about it. That’s why, I think, we play it safe.”

Symptoms of concussion can include unconsciousness, dizziness, confusion, blurry vision or headache. The key to recovery is rest to allow the brain to heal, Oyerinde said. Continuing activity can aggravate the injury and extend the recovery time, potentially leading to long-term problems, he said. Every injury that isn’t allowed to completely heal creates damage that accumulates.

It’s not just the traumatic head injuries that create risk. Now the medical community knows that even simple, less dramatic encounters create risk, Oyerinde said.

Unlike most physical injuries, brain injuries don’t show up on diagnostic screenings. Diagnosis is based on symptoms that may be subjective. Argent, with First Choice Physical Therapy in Minot, said at the professional sports level, testing sometimes is done to determine an athlete’s baseline brain response, which can be matched against responses following a suspected concussion.

Typically, though, doctors have to depend on the cooperation of the patient and the patient’s willingness to accept an injury and the requirement to rest, Oyerinde said. Rest is not just about remaining off the court or field but also avoiding intense brain activity, as might occur with video games or other highly stimulating events. How long the recovery lasts is dependent upon the injury.

Argent noted the North Dakota High School Activities Association requires coaches to have concussion training every year. Many teams also have trainers who decide whether an injured player is fit to play, avoiding the need for a coach, a parent or the player to make that decision.

Memory loss is the most common long-term complication, and it can show up years after accumulated damage, Oyerinde said. Sometimes the challenges of living with the damage can lead to psychological issues, such as depression.

“Parents also need to pay attention to the risk of concussion in children. We shouldn’t stop them from playing but we should be alert to when they are showing signs of a concussion,” Oyerinde said. The attitude of winning at any cost, including keeping an injured child in the game, needs to change, he added.

“It’s OK to lose this match for the sake of the health of the kids,” he said.