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Concussion Managment Launched in the Tri-Cities


By Michelle Dupler, Herald staff writer

Two students won't be playing football for Richland High this year -- or likely ever -- because of lingering problems related to concussions.

It's part of increasingly aggressive efforts to make sure that young athletes aren't permanently affected by the common brain injury.

Dr. Rich Jacobs of Northwest Orthopaedic & Sports Medicine in Richland said sometimes after a concussion an athlete can appear to be OK physically, but still have healing to do at the cellular level inside his or her brain. 

And if an athlete is cleared to play before the brain is fully healed, problems with memory, reaction time and focus mean the player is more likely to get injured again -- perhaps permanently.

"It's estimated 10 percent of football players will sustain a concussion over a year," Jacobs said. "We have learned over time when a person returns to activity and sport before the concussion is healed, they are more likely to re-injure and to have lasting injuries."

He hopes a new computerized testing tool he's brought to the Tri-Cities will ensure that doesn't happen.

Jacobs joined Northwest Orthopaedic on Aug. 2 after having practiced sports medicine at the University of Notre Dame in Indiana.

At Notre Dame, he used a computer test designed to evaluate athletes' cognitive abilities before and after a head injury to help determine when they're really ready to return to sports.

Athletes are tested on reaction time, memory skills and learning before a sports season starts -- when they're normal and healthy -- to get a baseline for comparison later.

Then when a player sustains a concussion or head injury, he or she is tested again after all physical symptoms have disappeared to make sure brain function is back to normal before being allowed to play again.

Jacobs said the point of the test is that physical symptoms and cognitive symptoms don't always perfectly align. Someone can appear outwardly to be healed but still struggling with things like memory and focus.

"We need the test to tell us when the brain has really healed," he said.

A concussion is an injury at the cellular level in the brain that doesn't show up on an MRI or other type of scan, he explained. So the best way to determine whether a concussion has healed is to test brain functions.

It also prevents a situation when an athlete may tell a coach or trainer he or she is OK to get back into the game even though not fully healed, Jacobs said.

"Sometimes they want to play so badly they're willing to tell a little fib or they're willing to deny those symptoms," he said. "If they take the test and don't pass ... we can with some objectivity say even though they're feeling better they're not fully healed."

Ensuring a player is fully healed isn't just a matter of good medical practice -- it's Washington state law.

The Zackery Lystedt Law was signed by Gov. Chris Gregoire in 2009 and requires that young athletes from high school football stars to Little League baseball players be removed from play if a concussion is even suspected. They can't return until they get written clearance from a licensed health care provider.

The law was named for a Maple Valley boy who sustained a brain injury in 2006 as a middle-school football player. Lystedt sat out for a short while, but then was let back into the same game and hit again -- this time sustaining life-threatening injuries.

Mike Neidhold, head football coach for Richland High School, said the computerized testing offered by Northwest Orthopaedic gives him another tool to keep his players safe.

"My one charge as head coach is player safety," Neidhold said. "When they do get a concussion -- in the old days we'd ask, 'Are you OK?' and they'd say 'Yes,' and go back to the game. Now we're finding kids get hurt (again). ... With the test we know they are OK. It will take some of the mystery out of this."

Jacobs wants parents to know they shouldn't be afraid to let their children play sports.

"Sport is safe," Jacobs said. "In fact, I encourage people to participate rather than not participate. We are just trying to make sport safer. That is really the point of using the test."

Richland, Hanford, Pasco, Chiawana and Tri-Cities Prep high schools all are using the test to measure their football players' cognitive skills and create a baseline going into the fall season.

Kadlec Regional Medical Center is funding the cost of testing.