New Caution Urged on Concussion in Sports

By TONY PERRY

March 13, 1997 12 AM PT

TIMES STAFF WRITER

Coaches in youth sports should be more concerned with even mild concussions and learn to administer tests to immediately determine the possible extent of brain injury to their players, researchers reported Wednesday.

“Coaches and players need to understand there is no such thing as a minor concussion,” said Dr. Jay H. Rosenberg, a neurologist with Kaiser Permanente’s San Diego Medical Center and a member of the research team that published the reports Wednesday in the journal of the American Academy of Neurology.

“While you can put ice on an injured knee or pulled muscle, you can’t ‘ice’ the brain,” Rosenberg said.

The report, which included original research and an analysis of numerous studies of sports-related head injuries, comes amid national concern about injuries to young athletes, including the death last fall of a high school football player at a game in Newport Beach.

The articles and proposed guidelines to test injured athletes represent a significant escalation in concern expressed by the medical establishment about one of the most common and undetected kinds of athletic injuries.

Rosenberg and other head injury specialists vowed to mount a campaign to persuade groups such as the California Interscholastic Federation, which regulates school sports, to adopt uniform guidelines on how to spot and assess concussion injuries.

The old standard, which states that unless an athlete loses consciousness he or she has not truly suffered a concussion, is wrong and harmful, the researchers said.

A neurology academy committee chaired by Rosenberg has devised simple memory and exercise tests that coaches can administer on the sidelines. Kaiser Permanente pledged to provide laminated, pocket-size cards to assist coaches and trainers in making evaluations.

CIF commissioners in San Diego and Los Angeles expressed interest in having the academy’s guidelines evaluated by coaches, trainers and physicians. Now, there is no statewide CIF rule on when a player should be removed from a game, with different regions and school districts free to adopt their own standards.

“A study such as this is of great interest to me,” said Barbara Fiege, CIF commissioner for the Los Angeles Unified School District. “It is my intention to provide coaches with as much information as I can. This is a very highlighted area right now.”

The guidelines have been endorsed by the American Orthopedic Assn., the Brain Injury Assn., National Athletic Trainers Assn., Pop Warner Football, USA Hockey and other groups.

“Nobody wants to see parents pulling their kids out of organized sports,” said Dr. Kenneth M. Viste Jr., president of the American Academy of Neurology. “We just want to make sure that once players strap on their helmets and play the game, their supervisors have all the necessary tools to provide the best immediate care possible, should the need arise.”

At a news conference in New York, the guidelines were supported by former pro football linebacker Harry Carson and former pro hockey player Brett Lindros, both affected by brain injuries suffered during competition.

“I learned that the brain, unlike a muscle, cannot be rehabbed time and time again,” said Lindros, forced into premature retirement from the New York Islanders.

Carson, who played 13 years with the New York Giants, suffers from the cumulative impact of multiple concussions.

One of the top concerns of the neurology academy committee is that--like Carson--young athletes are at great risk of damage from the cumulative impact of concussions, even if none of the concussions was bad enough to cause unconsciousness.

Adrian Taufaasau, a quarterback at Coronado High School in San Diego, died of a head injury suffered Sept. 20 in a football game against Costa Mesa High, held at Newport Harbor High School. He was 17.

Taufaasau, who had been tackled several times during his team’s 36-3 loss, was tackled by three or four players on what appeared to be a routine play.

Taufaasau did not regain consciousness after being tackled. He was pronounced dead two days later.

A four-month investigation by the coroner’s office determined that severe head and neck trauma had resulted in Taufaasau’s death, though an autopsy couldn’t determine whether one play or cumulative injuries killed Taufaasau.

Jerry Howell, Costa Mesa athletic director and football coach whose team played Taufaasau’s the night he was injured, said coaches have changed the way they teach tackling to help prevent head injuries.

“Back in the mid- to late 1960s, they used to teach that you put your head into the numbers [of the opponent’s jersey],” Howell said. “Now, we realize that is not only not safe, but it is also unethical for coaches to teach that.”

Howell said he has been trained to attend to anyone with a potential head injury.

“We have a couple of finger movement tests to see if the pupils dilate or don’t dilate,” he said. “We have some key questions and we evaluate based on how clearly they answer them. And there are some simple body movements, like drunk driver tests, that tell us right away that they can’t play until they have contact with a doctor.”

Tustin High School Head Football Coach Myron Miller said most coaches are trained in first aid and are taught how to spot injuries such as concussions.

“Every school I’ve ever been at, and I’ve been at nine in my career, you have to have CPR, first aid, and be able to test for things like concussions,” Miller said.

Most schools also assign certified athletic trainers to all games, and Tustin requires a doctor to be in attendance before any varsity football can begin.

“Any time a kid says there’s something wrong with his head or his neck or his back, he’s done. He’s not going back in,” Miller said. “Actually, it wouldn’t even be my call, it would be the doctor’s.”

John F. Kennedy High School Head Coach Mitch Olson said, “People are being really careful, more and more, because of the liability involved.”

At junior varsity and lower level games, Miller decides whether to pull a player. He said having a “checklist” of symptoms to follow would help him.

But at the varsity level, doctors and trainers are best equipped to determine whether an athlete should be allowed to play, not coaches, he said.

“In the heat of a ballgame, I don’t think it’s a great idea to have a coach make that decision,” he said.

In addition to the guidelines, the journal Neurology published articles by Rosenberg and Dr. James P. Kelly, director of the brain injury program at the Rehabilitation Institute of Chicago, and by researchers from the Northwestern University School of Medicine, the Rehabilitation Institute of Chicago and the Covenant Medical Center of Waterloo, Iowa.

In their article, Rosenberg and Kelly cite research that 100,000 concussions a year occur in football below the level of professional. Concussion is defined as trauma-induced alteration in mental status that may or may not involve loss of consciousness.

Concussions are divided into three categories. Grade 1 is confusion and disorientation that clears up within 15 minutes; Grade 2 is confusion and disorientation that lasts more than 15 minutes, and Grade 3 is loss of consciousness, regardless of brevity.

The guidelines suggest that for a Grade 1 concussion the athlete should be removed from the game and tested every five minutes until he is symptom-free; for Grade 2 the athlete should be pulled from the game, examined by a doctor within a week and not permitted to play again until he or she has two symptom-free weeks. For Grade 3 the athlete should be taken immediately to an emergency room.

Rosenberg said that until everyone involved with youth sports abandons the “macho mentality” that encourages playing with injuries, athletes will continue to be hurt by “second impact” injuries or cumulative impacts.

“The problem is that too many coaches and athletes view the Grade 1 concussion as just a ‘ding,’ or ‘getting your bell rung,’ a kind of rite of passage or Purple Heart that an athlete has to learn to endure,” Rosenberg said. “That’s just wrong. A brain injury is unlike any other injury to the body.”

Last fall, Reseda High football player Eric Hoggatt, 18, was found dead the morning after a game against Chatsworth High School. His parents have filed a wrongful death lawsuit against the school district, alleging that their son should not have been sent back into the game after complaining of dizziness and tingling in his extremities.

Since the death of Hoggatt, two partnerships have been formed between Los Angeles Unified high schools and medical groups to provide both professional and student trainers to athletic teams.

“It puts a very knowledgeable professional person on site, working not just reactively, but proactively to prevent injuries,” said CIF Commissioner Fiege. “This seems to be the wave of the future.”

Also contributing to this report were Times staff writers Martin Henderson, Paul McLeod and Lisa Richardson in Orange County and Steve Henson in the San Fernando Valley.

(BEGIN TEXT OF INFOBOX / INFOGRAPHIC)

Concussion Care

Rejecting the notion that there is such a thing as a “mild” concussion, researchers publishing in the American Academy of Neurology journal Wednesday urged closer monitoring of athletes and head injuries.

Signs of Concern

* Vacant stare

* Delayed verbal, motor responses.

* Confusion, inability to focus attention.

* Slurred, incoherent speech.

* Gross observable incoordination.

* Inappropriate emotions.

* Memory deficits.

* Any loss of consciousness.

What Is a Concussion?

Trauma to the head or neck causes disturbance of electrical activity in the brain, leading to unconsciousness.

Defining the Danger