Sports Medicine Panel Shares Concussion Insights



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Sept. 17, 2012

ATHENS, Ga. - University of Georgia director of sports medicine Ron Courson, along with a team of four expert panelists, recently led a brief concussion seminar for members of the media on the UGA campus.

The four panelists included head team physician Dr. Fred Reifsteck, Dr. Kim Walpert (neurosurgeon), Dr. Mike Ferrara (Associate Dean of Research and Director of Sports Concussion Lab) and Dr. Steve Macciocchi (neuropsychologist), who works at the Shepherd Center in Atlanta.

After a brief introduction by Courson, Dr. Walpert began the seminar by defining a concussion and the ways in which they can occur.

"A concussion is a brain injury that occurs when force is applied to the head or neck," said Walpert. "The brain, which is suspended within a sac of fluid, is then forced up against the inside of the skull, causing brain cells to tear and swell. Once this happens, the cells can no longer transmit important messages, and the brain doesn't work properly as a result."

Walpert also noted that while some concussion symptoms are more apparent, such as confusion or trouble with coordination, often times a number of symptoms exist that may not be easily observed by a team physician, most notably loss of memory or concentration. As a result, Walpert and the team of panelists emphasized the importance of increasing concussion awareness among athletes with the hopes that athletes can let a team physician or athletic trainer know if they do not feel quite up to speed.

"The athlete is as integral to our concussion management team as any athletic trainer or sports medicine personnel," said Walpert.

With increased awareness surrounding concussions in both professional and collegiate levels of football, Courson discussed the importance of focusing on the prevention aspect of concussions.

"In football, helmets do not prevent concussions," said Courson. "Helmets are designed to prevent skull fractures, and while they can help play a role in lessening the impact of a blow, they don't really prevent concussions. Contact with the crown of the head, such as what occurs in a helmet-to-helmet hit, is the most likely way to have a brain or neck injury, and we want to make sure that we're constantly reinforcing proper technique with athletes, officials and coaches."

Although football seems the most likely sport in which an athlete would suffer a concussion, Courson noted that other sports with a high incidence of concussions include cheerleading, soccer and equestrian.

Courson also commented that the Georgia sports medicine staff educates all athletes at the beginning of each sports season about the signs and symptoms of concussions, in addition to placing posters in the locker rooms to remind athletes about these symptoms throughout their season.

Each new athlete must undergo a baseline cognitive test upon their arrival to campus, with the exception of non-contact sports like tennis, golf and swimming. The tests are multi-faceted and include such aspects as a word memory or design memory tests using ImPACT Test Modules. The sports medicine staff also uses a symptom index and Neurocom balance exam as part of their baseline testing.

"If an athlete is thought to have suffered a concussion, they are put at total physical and cognitive rest," said Reifsteck. "We watch them closely for the first 48 hours because that time is the most important. We often use DHA as a supplement to help with the concussion since it's thought to potentially repair brain cells, but we do not administer any headache medications or anything that would alter their mental status."

If the athlete has not improved significantly after the first 48 hours, the staff may move on to a diagnostic test such as a CT scan. The key, as stressed by all of the panelists, is to simply treat each athlete individually by their symptoms rather than comparing to others' conditions. The athlete is evaluated on a daily basis.

Once the athlete is completely symptom free, the Impact and Neurocom tests are repeated. If these tests, along with the clinical exam by the physician, are normal, the athlete is cleared to begin a progressive exertion exercise program, starting with exercise on the stationary bike and progressing as tolerated, and symptom free, to running, weight training, non-contact activities and lastly contact activities.

Concussions remain a difficult injury to treat and diagnose since symptoms are not always clear from the outset, and while proper treatment of a concussion is vital, Walpert continues to emphasize the importance of prevention strategies.

"The recent rule changes in the college game are a wonderful way to help start change now, but the real key to changing the rate of brain injuries is to learn proper technique as a child," said Walpert. "I think the NCAA and NFL have done a great job of starting these programs, but we've just got a lot more educating to do."

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