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Bringing Student Athletes Back From Concussions Bringing Student Athletes Back From Concussions
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TORONTO — When the Canadian Paediatric Society updated its position on youth, sports and concussions in March, the recommendations struck a familiar chord for students and staff members at St. Michael’s College School in Toronto.TORONTO — When the Canadian Paediatric Society updated its position on youth, sports and concussions in March, the recommendations struck a familiar chord for students and staff members at St. Michael’s College School in Toronto.
Since 2011, the all-boys’ private school, generally known as St. Mike’s, has been running programs in partnership with the David L. MacIntosh Sport Medicine Clinic at the University of Toronto to support the recovery of student athletes who have sustained concussions, known medically as mild traumatic brain injuries.Since 2011, the all-boys’ private school, generally known as St. Mike’s, has been running programs in partnership with the David L. MacIntosh Sport Medicine Clinic at the University of Toronto to support the recovery of student athletes who have sustained concussions, known medically as mild traumatic brain injuries.
The progressive programs, Return to Learn and Return to Play, are spearheaded by Barbara Csenge, the director of student enrichment at St. Mike’s, and Dr. Michael Hutchison, the director of the university clinic’s concussion program.The progressive programs, Return to Learn and Return to Play, are spearheaded by Barbara Csenge, the director of student enrichment at St. Mike’s, and Dr. Michael Hutchison, the director of the university clinic’s concussion program.
Ms. Csenge, who previously worked at a Toronto children’s rehabilitation hospital and is familiar with traumatic brain injuries, proposed to the administration that the school standardize its approach.Ms. Csenge, who previously worked at a Toronto children’s rehabilitation hospital and is familiar with traumatic brain injuries, proposed to the administration that the school standardize its approach.
“I wanted something formal and medically directed,” Ms. Csenge said in an interview.“I wanted something formal and medically directed,” Ms. Csenge said in an interview.
Dr. Hutchison said he was delighted to join forces with the school. “We were doing something very similar,” he said. “The partnership allowed us to harmonize our approaches.”Dr. Hutchison said he was delighted to join forces with the school. “We were doing something very similar,” he said. “The partnership allowed us to harmonize our approaches.”
Concussions have long been an issue in professional football and hockey, but their effects were ignored for years, brushed off by administrators focused on the bottom line and by coaches raised in a culture of “toughness.”Concussions have long been an issue in professional football and hockey, but their effects were ignored for years, brushed off by administrators focused on the bottom line and by coaches raised in a culture of “toughness.”
Today, however, the issue is at the forefront of public consciousness, thanks in part to research on the damaging long-term effects of brain injuries and to lawsuits by former players against both the National Football League and the National Hockey League.Today, however, the issue is at the forefront of public consciousness, thanks in part to research on the damaging long-term effects of brain injuries and to lawsuits by former players against both the National Football League and the National Hockey League.
As a result, concern about concussion has trickled down to the amateur and school sports community. Statistics from the Public Health Agency of Canada for 2012 indicated that more than 40 percent of all braininjuries in young people 10 to 19 years old that were treated in emergency departments were related to sports or recreation. Meanwhile, statistics from the United States Centers for Disease Control and Prevention show that between 2001 and 2009 emergency room visits related to traumatic brain injuries from sports increased by 62 per cent for those younger than 19 years, with boys 10 to 19 showing the highest rate of concussions. As a result, concern about concussion has trickled down to the amateur and school sports community. Statistics from the Public Health Agency of Canada for 2012 indicated that more than 40 percent of all braininjuries in young people 10 to 19 years old that were treated in emergency departments were related to sports or recreation. Meanwhile, statistics from the United States Centers for Disease Control and Prevention show that between 2001 and 2009 emergency room visits related to traumatic brain injuries from sports increased by 62 per cent for those younger than 19 years, with boys 10 to 19 showing the highest rate of concussions.
The Canadian Paediatric Society’s updated position mirrors the program already in place at St. Mike’s. It advocates prompt medical evaluation and a gradual return to school and play. It also calls for education for all involved in youth sports and recreation so that they recognize the signs and symptoms of concussion.The Canadian Paediatric Society’s updated position mirrors the program already in place at St. Mike’s. It advocates prompt medical evaluation and a gradual return to school and play. It also calls for education for all involved in youth sports and recreation so that they recognize the signs and symptoms of concussion.
Ms. Csenge said her school’s formal concussion program was important. “Self-regulation is an issue for young people,” she noted. “They need support to comply with a graduated program, just as they need support to be disciplined in other areas. In our school community, we are dealing with boys who are seeking excellence, and they don’t want to sacrifice in one area.”Ms. Csenge said her school’s formal concussion program was important. “Self-regulation is an issue for young people,” she noted. “They need support to comply with a graduated program, just as they need support to be disciplined in other areas. In our school community, we are dealing with boys who are seeking excellence, and they don’t want to sacrifice in one area.”
“With less explicit medical management, the individual is left to self-manage and to make some decisions they are really not able to make,” she added.“With less explicit medical management, the individual is left to self-manage and to make some decisions they are really not able to make,” she added.
Students find it hard to take a time-out from the sports they love and from the social and academic aspects of school.Students find it hard to take a time-out from the sports they love and from the social and academic aspects of school.
“In Grade 11, I knew I was playing with a concussion for three weeks and I didn’t tell anyone,” said Nicholas Eustace, a Grade 12 student at St. Mike’s, who missed six months of school in two consecutive academic years as a result of two separate injuries. The lingering effects of the second eventually persuaded him to give up hockey, despite potential athletic scholarships and a chance at the N.H.L. draft.“In Grade 11, I knew I was playing with a concussion for three weeks and I didn’t tell anyone,” said Nicholas Eustace, a Grade 12 student at St. Mike’s, who missed six months of school in two consecutive academic years as a result of two separate injuries. The lingering effects of the second eventually persuaded him to give up hockey, despite potential athletic scholarships and a chance at the N.H.L. draft.
Education has played a vital role in helping the entire St. Mike’s community — students, teachers, coaches, administrators and parents — to recognize the symptoms of concussion and to understand both the potential damage and the need for a gradual, phased recovery program. When students come to the university clinic for a post-injury assessment, Dr. Hutchison and his staff reinforce that message to both students and parents.Education has played a vital role in helping the entire St. Mike’s community — students, teachers, coaches, administrators and parents — to recognize the symptoms of concussion and to understand both the potential damage and the need for a gradual, phased recovery program. When students come to the university clinic for a post-injury assessment, Dr. Hutchison and his staff reinforce that message to both students and parents.
“People who continue to be active during the recovery process experience symptoms longer,” Dr. Hutchison said.“People who continue to be active during the recovery process experience symptoms longer,” Dr. Hutchison said.
The concussion reintegration program at the school focuses on three dimensions of a student’s experience: physical, cognitive and sensory. For each dimension, there are six stages through which a student must progress in his return to the classroom; there is a separate, but similar, scale for a return to physical activity. For example, the initial stage on the sensory scale sharply limits time in front of television or computer screens, since the visual images and noise may stress the injured brain.The concussion reintegration program at the school focuses on three dimensions of a student’s experience: physical, cognitive and sensory. For each dimension, there are six stages through which a student must progress in his return to the classroom; there is a separate, but similar, scale for a return to physical activity. For example, the initial stage on the sensory scale sharply limits time in front of television or computer screens, since the visual images and noise may stress the injured brain.
Regular medical evaluations at the clinic assess where a student stands on each scale.Regular medical evaluations at the clinic assess where a student stands on each scale.
“This phased program allows them to see a progression and a roadmap of what they will go through and how the stages work,” Dr. Hutchison said. “Early intervention and normalizing the definition of a concussion is helpful in the recovery process.”“This phased program allows them to see a progression and a roadmap of what they will go through and how the stages work,” Dr. Hutchison said. “Early intervention and normalizing the definition of a concussion is helpful in the recovery process.”
Part of the challenge is that each concussion — and recovery path — is unique. One individual may find physical symptoms, such as headaches, disappear quickly, while sensory issues, such as sensitivity to noise, linger. Another may experience the opposite. There is also no standard timeline for recovery.Part of the challenge is that each concussion — and recovery path — is unique. One individual may find physical symptoms, such as headaches, disappear quickly, while sensory issues, such as sensitivity to noise, linger. Another may experience the opposite. There is also no standard timeline for recovery.
The Learning Center at St. Mike’s, run by Ms. Csenge, develops a reintegration plan for each student based on medical directions coming from the clinic. She and her staff refine it as the student heals, gradually returning to classes and progressing from a prohibition on taking notes or tests to full academic participation. Center staff members provide teachers with weekly progress reports.The Learning Center at St. Mike’s, run by Ms. Csenge, develops a reintegration plan for each student based on medical directions coming from the clinic. She and her staff refine it as the student heals, gradually returning to classes and progressing from a prohibition on taking notes or tests to full academic participation. Center staff members provide teachers with weekly progress reports.
The center also works with coaches and teachers to keep them briefed on the limitations of a student returning to sports. This, too, is gradual, with limited exposure to playbooks if there are cognitive issues and no team meetings if sensory concerns are present.The center also works with coaches and teachers to keep them briefed on the limitations of a student returning to sports. This, too, is gradual, with limited exposure to playbooks if there are cognitive issues and no team meetings if sensory concerns are present.
“Honestly, without the Learning Center, I wouldn’t be graduating this year,” said Nicholas, the twice-injured student, said. With its help, he added, “I’m keeping up academics-wise.”“Honestly, without the Learning Center, I wouldn’t be graduating this year,” said Nicholas, the twice-injured student, said. With its help, he added, “I’m keeping up academics-wise.”
The concussion program has benefited almost 400 students since its 2011 inception. Now, Dr. Hutchison and Ms. Csenge have grander plans. “Our goal is to have a process so that schools anywhere could use it to manage students with concussions,” Dr. Hutchison said.The concussion program has benefited almost 400 students since its 2011 inception. Now, Dr. Hutchison and Ms. Csenge have grander plans. “Our goal is to have a process so that schools anywhere could use it to manage students with concussions,” Dr. Hutchison said.
To understand the youth population better, the clinic does baseline testing on all students entering St. Mike’s, providing a basis for comparison when injuries occur. Dr. Hutchison would like to be able to do the same with a local girls’ school.To understand the youth population better, the clinic does baseline testing on all students entering St. Mike’s, providing a basis for comparison when injuries occur. Dr. Hutchison would like to be able to do the same with a local girls’ school.
“The clinic had expertise in medical management with the university population, but we’re now connected with the Grade 7 to 12 population so we can gain an understanding of the teenage population,” he said.“The clinic had expertise in medical management with the university population, but we’re now connected with the Grade 7 to 12 population so we can gain an understanding of the teenage population,” he said.
“Everyone wants to manage brain injuries better in the schools — and the government is saying we need to do so — but the schools are asking ‘How?”’“Everyone wants to manage brain injuries better in the schools — and the government is saying we need to do so — but the schools are asking ‘How?”’
Ms. Csenge said that her school’s project was a step toward establishing general principles for managing youth concussions: “We’re moving towards being able to quantify things and to recommend management principles, based on a pretty rigorous level of data collection,” she said.Ms. Csenge said that her school’s project was a step toward establishing general principles for managing youth concussions: “We’re moving towards being able to quantify things and to recommend management principles, based on a pretty rigorous level of data collection,” she said.