New program aims to protect brains…and save lives

Heads Up…It’s better to sit out one game than the entire season! We’ve all seen it…a cartoon character gets hit on the head, stars appear and the character walks around in circles. Today we would call that a concussion. And while it may be amusing to see on TV, it’s not so funny when it happens in real life.

Jake took a hit during warm-ups, but shrugged it off

What might seem like a small bump on the head may actually be the start of a much bigger problem. Rocky Mountain Hospital for Children’s new Center for Concussion is taking its message to the street ‐ and to the schools — in an effort to minimize the lasting effects of concussion due to sports-related injuries.

Jake Snakenberg

Jacob Snakenberg, April 19, 1990 – September 19, 2004

Karen McAvoy, PsyD had just embarked on a Centers for Disease Control study of concussions in high school athletes when, on Sept. 18, 2004, the subject hit tragically close to home.

As the school psychologist at Aurora’s Grandview High School, she received a call informing her that 14-year-old Grandview student Jake Snakenberg had collapsed on the football field after taking a fairly mild hit that morning. She’d learn later that he had likely sustained a concussion the week before, but without that diagnosis he promptly returned to play. Jake died Sept. 19.

“It was a devastating story,” recalls McAvoy, now the director of the Center for Concussion at Rocky Mountain Hospital for Children (RMHC). “It really shaped who I am, both professionally and personally.”

Fast forward six years, and McAvoy has dedicated her career to urging parents, teachers, athletic trainers and physicians to work together to betteridentify and manage concussions in youngathletes. In November, she published a sweeping concussion management protocol, The R.E.A.P. Concussion Management Program (Reduce, Educate, Accommodate, Pace), aimed at assuring that young concussion patients don’t return to school or play too soon, and do all they can to avoid the potentiallydeadly Second Impact Syndrome (severe swelling that can occur when a still-injured brain is hit again) that killed Jake.

The protocol, now used in four Colorado school districts, is among mounting nationwide efforts to change a somewhat laissez-faire culture around youth sports concussions.

“We have gone from believing that concussions are no big deal to understanding that they can have very serious consequences,” says Dr. Susan Kirelik, medical director of pediatric emergency services for Rocky Mountain Hospital for Children at Sky Ridge Medical Center in Lone Tree.

According to the Brain Injury Association of America, 1.6 to 3.8 million sports and recreation-related concussions occur in the United States annually, with football, basketball, cycling, soccer and playground activities the top causes. New research shows that, contrary to popular belief, kids are quite different than adults when it comes to concussions.

“It seems that, especially in adolescence, there is something about their brain that makes them vulnerable to not only having a concussion but also to having more complications,” says Kirelik, noting that kids also take longer to recover. “The average adult recovery takes one-to-two weeks, whereas kids can take three-to-five.”

Despite such facts, one 2009 study by the Center for Injury Research and Policy found that 40 percent of student athletes who suffered concussions between 2005 and 2008 returned to playing too soon. Even more alarming, according to the study, 15.8 percent who sustained a concussion and lost consciousness returned to play the same day.

Jake’s mother, Kelli Jantz, says she recalls her son complaining of tingling in his fingers after a game one week before his death, but his symptoms soon subsided and while he told his friends, he never told his coaches or parents his head was hurting.

On Sept. 18, Jake took a hit during warm-ups, but shrugged it off. “He looked at me and waved and everybody kept playing,” Jantz recalls. Moments later, Jake collapsed. Since then, Jantz has been working closely with McAvoy to assure that Jake did not die in vain. Their message to parents and coaches: Pay close attentionwhen a child gets injured, get them to adoctor if you suspect they have a concussion and make sure that concussion victims rest from both mental and physical exertion untiltheir brain heals.

“It hurts every day that he is gone,” says Jantz. “But if his absence and what he went through can prevent something from happening to someone else, that would be an amazing thing.”

How to Recognize and Manage a Concussion

  • Ask the right questions: Only 10 percent of kids lose consciousness when they suffer a concussion. If your child has a head injury, ask if they have these symptoms: headache, nausea, balance problems, blurry vision, sensitivity to light or noise, fatigue or brain fog. If they report several, see a doctor.
  • Recognize that symptoms can be delayed: “A lot of times we see concussion cases come in on Monday,” says Kirelik. “They play a game on Friday, don’t do much on the weekend, then go to school on Monday and use their brain to try to think”.
  • Rest: Insist that your child refrain from both physically and mentally strenuous activities at once. Avoid loud group functions, video games and text messaging, and limit reading and school work for the first few days. Don’t allow them to drive.
  • Keep them out of sports: Do not let them return to play until they are completely without symptoms. Once they return, start them off slow and easy. If symptoms return, pull them back out and wait.
  • Tell young players to speak up: Before the season starts, have a conversation with your child about reporting their symptoms to the adults in heir life. “We still have a culture that advises kids to ‘suck it up’ and many of them think they are being wimpy if they tell their coach they have a headache,” says Kirelik. “They are really putting their brains at risk.”
  • Stay positive: 90 to 95 percent of kids whose first concussion is properly managed will completely recover. “It is the kids who have multiple concussions or second head injuries while still healing who can go on to have real issues,” says Kirelik.