BEST OF 2014: Concussion Treatment Program Puts Focus On Academics

Dec. 22, 2014, 6:45 a.m. ·

Recent return-to-learn provisions are focusing on athletes’ re-entry into the classroom following a concussion. (Photo by Ben Bohall, NET News)

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Concerns over concussions are often at the forefront of student athletics. NET News takes a look at how concussion research and recent Nebraska legislation are affecting student athletes both in and out of sports.

Becky Wardlaw taped the hands of a defensive lineman like she's done it a thousand times before. She’s the head athletic trainer for the Papillion La Vista South High School Titans. It was special night for the Titans. The team is 6-3 on the season, and earned a spot in the first round of the Class A Nebraska high school football playoffs.

Becky Wardlaw is the head athletic trainer for the Papillion La Vista South High School Titans and a member of the school's concussion management team (Photo by Ben Bohall, NET News)

As kickoff approached, Wardlaw paced the team’s sideline waiting for the inevitable. With a full contact sport like football, there would be injuries. And while they’d include the likes of sprains, tears, and breaks; concussions could, and often do make the list.

A concussion is defined by the Centers for Disease Control and Prevention as a type of traumatic brain injury caused by a bump, blow, or jolt to the head that can change the way a brain normally works.

The growing popularity of the National Football League over the past two years has increased concerns over concussions. Those concerns have been shared by Nebraska State Senator Steve Lathrop of District 12 in Omaha.

“And it’s not just football,” Lathrop said. “Concussions are a problem in soccer, for example, and some of the other sports that young people are involved in. Making sure that they don’t get two concussions or a second concussion before they’re recovered from the first is important to avoid brain injuries.”

In 2012 the Nebraska Legislature passed a bill introduced by Lathrop known as the Nebraska Concussion Awareness Act. LB 260 mandated a return-to-play program dictating student athletes, under the age of 19, who suffered a concussion, would have to be cleared by a licensed physician before returning to sports activity. But last summer, the bill was amended to include return-to-learn provisions that would also focus on athletes’ re-entry into the classroom following a concussion. The amendment reflected a growing pool of research showing that cognitive rest following a concussion can be far more important than physical rest.

In 2012, the Nebraska Legislature passed a bill introduced by Omaha State Sen. Steve Lathrop known as the Nebraska Concussion Awareness Act. (Photo courtesy of Nebraska Legislature)

“Often times, if the athlete is experiencing headaches or problems in concentration and they try to push it, then they finally fatigue more, have trouble concentrating, and so on,” said Dr. Dennis Molfese, the director of the Center for Brain, Biology and Behaviour at the University of Nebraska-Lincoln. “The best advice there is to back off… If you’re experiencing headaches after 15 minutes of trying to study, then next time try for 10 minutes. If you can do it for 10 minutes, that’s great, go back, take a break after that, try it again for 10 minutes, then gradually lengthen it… In all except about 10 to 15 percent of the cases, a person gets over the concussion effects in one to two weeks.”

Following the passage of the Concussion Act, and its return-to-learn amendment, schools across the state established concussion management teams. The goal was to provide both physical and academic support for athletes following a concussion. The practice described by Dr. Molfese is just one example of how teams work in collaboration with parents, physicians, and teachers to prevent a student from overexerting him or herself in academics.

Becky Wardlaw is on Papillion LaVista South High School’s concussion management team. She’s employed privately by Catholic Health Initiatives, and the school contracts her services through the health organization. While her primary role is that of an athletic trainer, a big part of her job has been to ensure student athletes aren’t experiencing cognitive problems in the classroom following a concussion. She said there are several triggers in a school environment.

“A lot of times the noise in the passing periods, in the hallways makes their headache worse. A lot of times an overhead projector or even just trying to follow along in a textbook when someone else is reading or they’re trying to read. It can make their headache worse. Or, they might have to go back and read it multiple times because they’re not cognitively understanding what they’re reading… That all can stimulate and make their symptoms worse,” Wardlaw said.

Concussions are a hot topic in today’s sports world. It’s not just a headline; it’s a medical mystery and an ongoing research study. Like most things about the brain, science is still learning what damage concussions can cause to an athlete. So the big question is this: What is being done to protect our athletes in sports like football, wrestling, and even soccer? Find out more in the NET Sports program Concussions: Heading for Change.

And while students have seen the benefits of the return-to-learn protocol, there have been speed bumps along the way. According to Dr. Molfese, ensuring a student athlete recovering from a concussion gets full mental rest can be a struggle.

“The issue is if you tell somebody to rest, what do they do with rest? What do you do? What happens is, everybody does something. So maybe they’re thinking, ‘I’m going to rest, I’m not going to study,’ but then they’re on their telephone. Or now they’re working on some sort of app or playing games on the computer. That’s not necessarily mental rest. That can, in many ways, be just as strenuous as doing something else,” Molfese said.

But perhaps the biggest obstacle to overcome has been a lack of certainty. So much still remains unknown on how to properly diagnose and effectively treat all the symptoms associated with a concussion. The CDC has listed 15 identifiable symptoms of concussions, but there’s no way for medical practitioners to know for sure. Molfese said while return-to-learn and return-to-play provide strong guidelines for educators and trainers to follow, the answers will come from future research.

“What we have out there are a lot of interventions that are based on common practice but very little research to back them up or no research. It does make the need for advanced research super critical. Right now, we put our physicians in a very precarious position where they’re having to aid their patients and they have very little to go on. It’s not their faults, it’s our fault as researchers. We haven’t provided them with the information,” Molfese said.

Editor's note: This story is part of our "Best of 2014" Signature Story report. The story originally aired and was published in November.