A concussion is not just a bonk on the head.
It is not an athlete's badge of honor.
It is a brain injury with life-altering consequences if not handled correctly. Which is exactly the point of Nebraska’s Concussion Awareness Act, effective Sunday, said Lori Terryberry-Spohr, brain injury program manager at Madonna Rehabilitation Hospital.
The law, which mandates concussion education for coaches, parents and players and sets rules of play for youth suspected of having a concussion, is designed to raise awareness and prevent the tragedy of second-impact syndrome or death, said Kate Kulesher Jarecke, executive director of the Brain Injury Association of Nebraska.
According to the Nebraska Athletic Trainers Association, 136,000 concussions occur each year nationally in high school athletics. That number probably is higher, as only about one in 10 are reported and tracked, said Jarecke, citing national findings by the Centers for Disease Control and Prevention.
A dozen known cases of second-impact syndrome have occurred in Nebraska -- the one known widely in Lincoln is that of Brady Beran, a Lincoln East High School student who nearly died after suffering a concussion during a football game in 2004. Unbeknownst to anyone, the student-athlete had suffered an undiagnosed concussion days earlier.
Injuries like Beran’s are rare but concussions are not, Jarecke said.
And in the last few years, more and more is being learned about how concussions affect the brain and specifically why people need to pay attention and give the brain time to heal.
“They can have lifelong consequences if they have not recovered from the first concussion before they go back into play,” Jarecke said.
The Concussion Awareness Act was approved during the 2011 Nebraska legislative session.
The law has three main components, Terryberry-Spohr said. The first is education. By law, all youth sports organizations -- not just school teams -- must offer all coaches, athletes and their parents information about the risks and symptoms of concussions and how to seek proper medical attention.
No specific training is mandated. However, the Nebraska Department of Health and Human Services offers a free online 15- to 20-minute training program at www.dhhs.ne.gov/concussions. The new law requires no record-keeping, no additional spending and no penalties for noncompliance.
“We were not looking to get coaches fired. We just want to make sure athletes are protected and that people understand a concussion is a brain injury,” Jarecke said.
Concussion education must be offered annually to coaches, youth and parents. Many organizations are getting the word out through flyers.
Emphasis is on recognizing the signs and symptoms of concussions, and taking precautions, Jarecke said. You cannot see a concussion. Sometimes athletes do not experience or recognize symptoms for hours or days after the injury, which is why it is imperative others be aware of the signs, Jarecke said.
Symptoms can include appearing dazed or stunned; confusion about an assignment or position; being unsure of the game, score or opponent; moving clumsily; and/or talking slowly. People with concussions may lose consciousness; complain of a headache or pressure in the head; experience nausea or vomiting; have double or blurry vision; have sensitivity to light or noise; feel groggy or in a fog or just “not feel right.”
“A lot of people don’t understand a concussion,” Jarecke said. “It is a brain injury. … You would not send a kid with a torn ACL back in to play soccer, and you shouldn’t do that while the brain it healing.”
After a concussion, the brain needs physical -- and cognitive -- rest, she said.
“It is cognitive activity that slows down the recovery from a concussion,” Jarecke said. “It doesn’t mean sitting in front of a computer and playing video games. It means you need to rest.”
The second and third components of the new concussion awareness law clearly spell out how coaches will handle suspected concussions:
* Under any reasonable suspicion of concussion, coaches will remove youth athletes from play.
* Youth athletes will not be allowed to return to play, including games, scrimmages and practices of any kind, until written approval from an appropriate licensed healthcare professional AND the youth’s parent or guardian is obtained.
The law defines a “licensed healthcare professional” as a physician, physician’s assistant, nurse practitioner, athletic trainer, neuropsychologist or or any licensed healthcare worker in Nebraska who is specially trained in pediatric traumatic brain injury.
Riley Washington, director of the Nebraska Football Academy at Lincoln’s Abbott Sports Complex, said he has had three kids with concussions over the past few years -- two of those kids got concussions doing something other than football.
“We take concussions seriously,” he said. Despite what kids may want, coaches and trainers emphasize if there is any question over a head injury, the player sits until cleared by a physician and the parents.
As for the be-tough-and-suck-it-up attitude of football, Washington is firm:
“If you’re hit hard, suck it up. If you’re feeling dizzy or having a headache -- it is not a matter of sucking it up. It is a matter of sitting it out.”
It’s a message he has spent the past seven months getting across to his coaches and staff and ultimately will deliver to the parents and athletes.
The new law is designed to create concussion consistency across the state -- with pint-sized youngsters to hulk-sized young adults.
“The more consistency we get, we think the more compliance we will get, and more understanding of why it is so much more serious than we ever realized 20 years ago,” said Terryberry-Spohr.
The findings -- especially coming out of the National Football League -- indicate players who have received multiple concussions are more prone to thinking problems, depression and other brain-related issues, including dementia.
Most kids will argue they don’t need to sit out after getting a hard hit.
But statistics find that 90 percent of second concussions happen within 10 days of the first.
Concussions affect reaction time, balance, vision and processing speed -- thereby increasing the likelihood of a second concussion and debilitating brain damage.
National research finds that one minor injury -- concussion -- is usually not hugely serious, Terryberry-Spohr said.
“Ninety percent recover completely in a few days or a few weeks,” she said.
“The real problem is when you get second and third injuries. If they are too close together, we see much more serious problems -- cognitive issues, depression, emotional issues and worst case scenario -- full hemorrhages and bleeds.
“They are rare, but they do occur in Nebraska,” Terryberry-Spohr said.
Which is why everyone from medical professionals to state athletic organizations, including the Nebraska State Athletic Trainers Association, pushed for the Concussion Awareness Act.
“Consistency is so important. We cannot wait 20 years for everyone to get on board with this,” Terryberry-Spohr said. “The consequences are so serious -- one out of four athletes will have a concussion before they are out of high school. If we don’t manage it, it will put kids at risk.”