Came across this today and thought I would pass it along:

The Impact of Concussions on High School Athletes, Congressional testimony of Gerard Gioia, PhD

Very good article.

IT would be so good if all high schools could get a copy.

Donna

I am glad to see someone taking this issue to Congress. Unfortunately, Dr Gioia is repeating some of the same falsehoods that have been a big part of the problem.

He wrongly states <The length of time for a full recovery following
a concussion – and of functional impairment – varies from days to months. For most, it takes at least several weeks.>
Not only is there no evidence to support this statement, but there is long standing evidence to disprove it.

He also states from the CISC <be restricted from activities until they’re fully healed. The important roles of parents and the school were also highlighted>

There have never been any valid standards for return to activity. The ImPACT Test and CNS Vital Signs test are woefully inadequate. They are a good start as they help parents and students better understand the need for extended non-activity.

Fortunately, he acknowledges a serious lack of understanding as to the students with persistent symptoms.

<A portion of students have persisting problems with school learning and performance long after the acute effects of the concussion. We do not yet understand the reasons for these poor long-term outcomes, and must study them further. A high percentage of student-athletes with concussion/ mild TBI experience short- and medium term problems with school learning and performance. These academic problems, even if temporary, can have potential negative consequences for the student down the road. And, if unidentified and untreated, these problems can have significant long-term consequences for the student.>

He has this nailed this last issue. PSAT's, Merit Scholar Tests, SAT's ACT's and routine academic tests that effect the student's permanent GPA can forever change the opportunities available to the student.

He is unfortunately too vague about "if unidentified and untreated." For many, the only treatment available is accommodation by teachers in testing and other grade effecting evaluations. There needs to be a avenue to have academic failures due to symptoms deleted from the academic record allowing the student to retake or delay finishing a course until proper accommodations and assistance is made available.

He calls for federal involvement when he should instead be calling for local awareness. The feds will get in the way as they create ineffective bureaucracies. The local schools need to be aware of these issues with access to local services and diagnostics.

I have a hard time understanding why there is so much resistance to accepting the fact of concussions causing long term consequences. Do the schools worry about liability law suits? Here in Idaho, our state school athletic association objected to 'informed consent' and other informational requirements as presented by a concussion bill this past February. The gutted bill that resulted and was passed and signed by the governor is worthless.

I could go on but I think I have said enough for now.

I lived this exact same problem in high school from 1969 to 1973. Not much has changed in 35 years.

I'll have to disagree with you Mark. I think things have changed and continuing to evolve in terms of concussion management and high school athletes. It's not going to happen over night but steps are being taken in the right direction.

Dr. Gioia testimony is a great step towards raising the awareness of the cognitive struggles these kids face returning to school (or anyone for that matter). Much of the literature out there for schools/parents/coaches - place an emphasis on returning to play and don't spend much time talking about the return to school piece.

It is also true that everyone recovers at different rates. Some people do make full recovery. It is true that they don't understand why some people are lingering issues and other don't. This needs to be studied.

Actually, the research shows that nobody makes a full recovery. They may appear to make a full recovery but when the brain is put under stress, the lingering problems will become evident. When the medical and psychological industry start telling this truth, then things may start to change.

The problem is the threshold of "full recovery." It is expensive and or impossible to measure because there is a need for a before and after assessment of mental capabilities. A neuro-psych assessment is only done after a problem.

The ImPACT Test and CNS Vital Signs Test try to address this with baseline testing. It is not possible to get a complete baseline in just 30 minutes of computer testing. They are both a good start just as Dr Gioia's testimony is a good start.

Drs Gioia and Collins have created some evaluation protocols as a weak start. I have copies on my desk. The need for accurate self-reporting is a big problem, especially with athletes. The insurance companies and other responsible parties continue to fight against any recognition of long term problems. Only the worst and most obvious symptoms are recognized and even those are often attributed to somatic, malingering, and litigation issues.

The courts continue to rule that most diagnostic procedures that point to concussion are imprecise. The obvious brain injured get rehabilitated to levels that are considered a full recovery because they can live independently. They still have many limitations. It appears that full recovery means 'recovered as much as possible.'

It is those of us who never lost motor function who are considered 'fully recovered' because the rehab specialists can not help us recover any more. Most people consider me fully recovered from all outward observations. But ask my wife. She will tell you about how each concussion has led to less recovery wit more pronounced residual problems.

I used to think I was fully recovered until my concussion in 1996. When I asked others about how they observed me. They all saw changes that did not recover, dating back to 1965. When I charted my concussions and compared them to my academic record, I saw a direct correlation.

For some, the long term symptoms may just appear to be a greater level of symptoms from the next concussion. This is the only issue that many professionals agree on.

The same argument goes on regarding marijuana and alcohol. But the science shows that both increase the risk of later problems. Just a few "blotto" alcohol experiences in the teens will effect the person for a lifetime. Long term moderate use of marijuana greatly increases the risk of psychosis later in life.

But by listening to the mainstream both are considered to be benign as long as you avoid operating automobiles.

When there is a lnadmark decision that places liability on the entity that failed to provide proper informed consent, one will likely see a drastic change in how concussion is presented.

We have always had competitive sports but the intensity is getting much higher. Girls want to get sports scholarships. Guys compete for extremely competitive scholarship opportunities. The 'shake it off and play harder' mantra is still in the minds of most athletes and many coaches.

Our prisons are full of concussion caused brain injured people. The numbers are thought to be 60 percent or more with brain injuries.

We need the industry to stop saying "FULL RECOVERY." It enables athletes to continue to get injured. They then negatively impact a society that has very little tolerance for their struggles.

Well, it looks like rain and my soap box will get slippery. LOL.

Mark-

I have to disagree with you to a certain extent regarding the issue of "never recovering". From my experiences as an athlete, I know of quite a few who have sustained a concussion and fully recovered with in a couple of weeks. I even had a teammate collide with another person and was knocked out, having memory problems at the initial scene, who recovered two weeks later, and was completely back to her normal self.

I have had two concussions, and the first concussion I had I was out for three weeks with headaches. This second one has been far worse, but to date, I'm feeling significantly better and go days with out headaches now. The only lingering issue I'm having is a neck and back problem.

Naturally there are worse concussions than others, but just because you sustain a concussion- really bad or "not so bad"- surely doesn't mean that your brain will never fully recover? I think what is so hard, is there is no way to make generalizations about the brain- it is just way to complex.

I believe two components play into my lingering symptoms- the amount of impact and I was just one of the unlucky ones....