Dec. 17–AUGUSTA, Maine — It’s an injury sometimes treated with virtual darkness, but efforts continue to bring light to the battle against concussions in Maine.
A state law required all school boards statewide to develop concussion management policies by mid-2014, mandated training for coaches, athletic administrators and other school personnel in the identification and management of concussions, and required that a concussed student not return to a sport or the classroom until cleared by an appropriate healthcare professional trained in concussion management.
And while no firm statistics are yet available on the level of compliance with the law across the state, sports medicine experts in Maine believe awareness about concussions and how to treat them has increased markedly.
“What that law does is help educate more than anything else,” said Dr. William Heinz, a Portland physician who chairs the National Federation of State High School Association’s Concussion Summit Task Force and is a liaison to the sports medicine committee of the Maine Principals’ Association, which oversees interscholastic sports in the state.
“What it’s doing is getting those schools that may have been paralyzed and didn’t even know what first step to take to have some kind of concussion management team in place. It’s getting them to start taking that first step and move along from there. I think that’s been important.”
Challenges for school systems can range from financial considerations amid tight budgetary times to finding local healthcare providers with sufficient concussion-specific training,
“It is being implemented,” said Dr. Paul Berkner, director of health services at Colby College in Waterville and president of the Maine Concussion Management Institute.
“But to be honest, some schools are struggling to figure out how to put it in the context of their school, so it’s not been perfect but the schools have done a really great job of trying to incorporate this. They’ve incorporated the education piece. They’re creating teams of administrators and school nurses and athletic trainers to help manage those students when they do get a concussion. But it’s not easy, and it’s not all going to be done tomorrow.”
The Maine Concussion Management Initiative is active in providing opportunities for school staff, medical providers and others interested in concussion management as a means to aid school districts in developing access to a pool of local personnel up to date on the subject.
“Schools are trying to figure out how to implement another mandate in their system that they clearly know has an impact on their students, there’s just a learning curve to it,” said Berkner. “We have a solid corps of volunteers across the state who are educating schools, school administrators, physicians, volunteers, parents, coaches and athletes about the risks for concussions, and the schools have really stepped up to the plate.
“Every school is learning from the ground up how to do this, and every school has its own challenges. Big schools have a lot of kids. Small schools may not have an athletic trainer or they may not have a school nurse there every day, so there’s no one reason schools might be challenged in implementing the program.”
The state Department of Education is expected to learn the level of compliance with the concussion management law statewide as part of a 2015 questionnaire on the issue.
Nancy Dube, school nurse consultant for the Department of Education, said that through her communications with school nurses around the state she believes progress has been made.
“I know from my experience that school districts are working very hard to have policies in place and come into compliance,” she said.
Dube did conduct a survey on how many school nurses statewide managed students with concussions during the 2013-14 academic year, and 207 of 303 respondents– or 68 percent — reported dealing with at least one concussion case.
How that compares with previous years isn’t known, Dube added, because there are no similar statewide statistics available from previous years.
“The challenge is that for the first time last May we asked school nurses to share with us how many children they dealt with for concussions and how many concussions they dealt with, how many were medically managed, that kind of baseline information,” she said. “Before that we had very inaccurate data because some (nurses) weren’t even hearing that there were concussed kids, and at some school districts if the concussion happened outside school they didn’t even know.
“What I’m finding happening with the new law and policy is that even if it’s happening outside school — let’s say a child is on a sports travel team and something happens on a weekend — the nurse now often hears about it on Monday morning.”
The participation total for Maine high school sports was 52,531 in 2013-14, according to the National Federation of State High School Associations. The total counts an athlete each time they participate in a sport.
Educational resources related to concussions have become more plentiful statdewide in recent years through events such as a concussion seminar held for LTC football coaches in Orono a year ago to NFHS concussion management guidelines published on the MPA website as well as the video “Concussion in Sport — What You Need to Know” available on the NFHS website — www.nfhslearn.com — that Maine high school coaches must complete.
“We have a coordinated statewide program around concussions and concussion management,” said Berkner. “I think we have a group of dedicated volunteers and a group of dedicated school administrators and healthcare professionals that are really taking the lead on this in the state of Maine. It’s one of the reasons why I love living in Maine, because we can get stuff done here.”
One fairly immediate priority for leaders in the field of concussion management is to determine the actual prevalence of the injury in Maine.
“We all are aware of it in our clinical practices but there’s no data collection at a really good level yet that will allow us to say, ‘Yes, there has been an increase,’” Berkner said. “There have been some small studies out there in small population bases that have said, Yes, we see an increase,’ but I don’t think we can extrapolate that out to the general population even at a state level yet without gathering the data. That’s our goal here.”
Nationally, the rate of concussions more than doubled for high school athletes between 2005 and 2012, according to a study in The American Journal of Sports Medicine. The study noted that the increase was likely due to more awareness and legislation for student-athletes.
Baseline measurements such as ImPACT (Immediate Post-Concussion Assessment and Cognitive Testing) provide a starting point for Maine school and medical personnel. Through ImPACT, student-athletes are tested before the start of a school year for comparative use if a student subsequently experiences concussion-like symptoms.
ImPACT, whose founders include Dr. Micky Collins, a Hermon native who is the clinical and executive director of the University of Pittsburgh (Pennsylvania) Sports Medicine Concussion Program, has been made available to more than 100 high schools statewide and approximately 15 middle schools through the Maine Concussion Management Initiative.
“Clearly the No. 1 priority is ensuring that students are able to succeed in school once they have had a concussion,” said Berkner. “Athletics are important but academics are primary, and concussions really impact a student’s ability to participate in school. That academic piece really can impact on a student’s ability to succeed, so our focus is how can we do a better job of managing that part of it.
“The school nurses across the state have done a fantastic job of identifying that as a priority within the schools, working with school administrators to make sure students are getting the short-term services they need so they can recover from their concussions as quickly as possible.”
Also under development is an injury surveillance tool that potentially will allow for the anonymous collection of concussion-related statistics from schools around the state.
Called Head Injury Tracking or “HIT,” the four-year project funded through the Department of Health and Human Services is being piloted at 11 Maine high schools and 11 Division III colleges.
“Every state across the country is trying to gather this data but it’s not easy to gather,” said Berkner. “This is a simple, secure and confidential webpage that allows us to collect de-identified information from the schools that we then collate and pull together data sets around where concussions are occurring, how they look, and how long it takes students to get back to school.”
Officials involved with implementing HIT eventually hope to expand the project to schools throughout Maine and use the accumulated data to address trends both within individual communities and statewide.
“Concussions are going to happen,” said Dube. “The best thing we can do is mitigate them so they resolve quickly by what we know about brain function and the fact that if the children rest for the first few days and have limited use of their brain then their brain has a much better chance to heal overall.
“The brain is a major computer that needs quiet time, and my hope is that what we’ll see after collecting the data is that (initial) concussions last for fewer days and that they’re better managed and the children become symptom-free and we can reduce the number of second and third concussions that happen in close proximity.”