Baseline tests hold key to concussion return

By Matt Jones

Posted: September 12, 2012 at 5:12 p.m.

Rick McFarland Arkansas Democrat-Gazette/RICK MCFARLAND --09/08/12-- Arkansas cornerback Tevin Mitchel (right) is attended to after a hard hit against Louisana-Monroe. Mitchel was taken from the game on a stretcher and diagnosed with "an injury above the shoulders".

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FAYETTEVILLE — University of Arkansas athletics concussion policies are based on individual testing, not a set timeline as some other institutions use.

Athletes are given "baseline" examinations prior to the season. The results of the exams are used as references in post-concussion testing, and include balance testing and computerized neuropsychological screening.

"Baseline tests show what an athlete does when healthy - memory, cognitive abilities, reaction and all that stuff," said BJ Maack of Arkansas Sports Performance Center in Little Rock. "If they do that again after a concussion, you can compare the two tests and see."

According to the Razorbacks' concussion management policy, athletes suspected of a concussion are removed from competition for evaluation and those diagnosed with a concussion will not return to activity that day.

Concussion symptoms include vomiting, imbalance, dizziness, nervousness, nausea, sensitivity to light or noise, numbness or tingling, headache, drowsiness, sadness, fatigue, difficulty remembering or concentrating and loss of consciousness.

Once symptoms and post-concussion assessments are within normal baseline limits, return to play should follow a medically supervised process, according to the policy.

Athletes with concussions are evaluated by Dr. Ramon Ylanan of Advanced Orthopaedic Specialists in Fayetteville. The final decision for return to play is Ylanan's and can't be challenged.

"As with all conditions, no one clinical factor can be used to either diagnose concussions or determine when return to activities is safe after concussion," the policy states. "Symptoms, clinical evaluation, diagnostic studies and testing such as neuropsychological tests all must be weighed in the decision."

The Razorbacks' policy is different than the return to play protocol by the Arkansas Activities Association, which governs high school athletics in the state. The AAA states return to play should not be allowed within five days of any concussion symptoms.

Maack works with high school players on a routine basis. He said the number of concussions have risen by a substantial rate in recent years because of a greater awareness of the injury's severity and the dangers of multiple head traumas.

"If you have a kid that comes in with a concussion, the problem isn't necessarily that concussion," Maack said. "What you can't have happen is a second concussion. The kids you read the horror stories about that can't walk anymore or can't function are the ones who have had the repeated trauma without the brain having a chance to heal.

"A concussion is something to take seriously. That's why there are established guidelines on when they can come back."

The AAA has a five-step policy for athletes to return from concussions, ranging from light conditioning exercises to full team practices, with at least 24 hours between each step completed. An athlete also must attend a full day of school if it is in session.

If concussion symptoms reoccur during any of the steps, the athlete must restart the process.

"The goal is to gear back up to game day again," Maack said. "Once the athlete has completed all the steps without any symptoms, you can say he's healed.

"If a high school kid is diagnosed with a concussion on Friday and feels fine on Saturday, then the five-day clock begins Sunday. He might be able to return by the next Friday, but that's fast."

Injuries above the shoulders have been diagnosed to three football players for the Razorbacks this season, though none have been officially declared concussions. A university spokesperson declined to more thoroughly detail the diagnosis.

Receiver Cobi Hamilton suffered an injury above the shoulders in Arkansas' season-opener against Jacksonville State and returned to play for the Razorbacks' game against Louisiana-Monroe the next week.

Quarterback Tyler Wilson and cornerback Tevin Mitchel were diagnosed with injuries above the shoulder in the ULM game. Neither has been cleared for Arkansas' game against Alabama on Saturday.

The Southeastern Conference created a working group to study concussions at its annual spring meeting in June. The group is led by University of Mississippi Chancellor Dan Jones and also consists of two specialists with expertise in head trauma, two team doctors and two athletic trainers.

"We want to make sure we are doing everything that we possibly can to protect our student-athletes," SEC commissioner Mike Slive said. "The nation is addressing the issue and we want to make sure that we are doing our part. The bottom line is, how do we protect our student-athletes?"

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