4/13/2012 5:24:00 AM Reducing hit counts may help reduce concussions One student-athlete suffered from the results of accumulated hits
Concussions can mean lost time in the classroom, too
Effects of head injury don't stop on the field
By Bryan Rose
of The Lakeland Times
You're sitting down to take a test in one of your classes at Lakeland Union High School.
You have studied and know the information cold. The problem is you can't read the words on the page.
You're not illiterate, but the words are jumbled, blurry or you see two of everything.
These are the effects a concussion has on the academic lives of athletes as they struggle with this ailment that is becoming more prevalent in high school sports.
And while in the past, schools and students may not have known what was happening to them or how to deal with it, students at Lakeland now have somewhere to turn.
Enter school nurse, Geralyn Knautz.
"I guess I am the case manager," Knautz said. "I am the pivot person keeping all the parties up-to-date."
Knautz is responsible for keeping track of the concussion plans and keeping doctors, parents, teachers and students apprised of the progress of the player who sustained the concussion.
And it all starts with the concussion plan.
"Once a concussion is diagnosed, the doctor will develop a concussion plan with restrictions - academic, physical or whatever - and that paperwork gets to me and I keep all faculty, counselors, attendance secretaries and coaching staff up-to-date about what is going on."
Sometimes that includes half school days and balancing schedules because of what a concussion does to a student's ability to learn.
"When someone has a concussion, they cannot remember, they cannot formulate quickly," Knautz said adding that doublevision or blurred vision can also be complications.
Because of that, doctors can sometimes put students on half-day restrictions.
"I will look at their schedule and set up a plan where they are in their morning classes on day and their afternoon classes the next day," she said. "Then I keep alternating until they can return to a full schedule."
For some concussion sufferers, half-day restrictions are not needed but other restrictions may apply.
"They may be on a no-testing restrictions or a no-reading restriction," Knautz said.
Other factors may also come into play when a student is suffering from a concussion.
"A lot of the kids can't handle the fluorescent lights that we have here at the school," she said. "We touch base with the kids to let them know that if they have any problems at any time to come and see me. I will let them lay down for a while."
While Knautz works to make the students comfortable on campus, she also keeps track of the students' progress.
"I keep a concussion flow [chart] of all the students and I keep the medical staff on top of where they are at with each kid," she said. "I email the updated flow to them once a week."
Sometimes that flow can show a regress in progress.
"We just had one kid that went backwards," Knautz said. "She started out with no academic restrictions but she came to find that she couldn't concentrate and had doublevision. So that has happened a few times."
Knautz said all these precautions are to make sure the student is fully recovered before they can return to the playing field.
"After a student is back to their baseline, the restrictions are rolled back slowly and they get a return to play protocol," Knautz said. "The student is eased back into the sport. They do some cardio testing to see where they are at. Then they practice under observation and get them back to where they are fully ready to play. This can take a long time."
Knautz said the entire process requires constant communication between herself, Dr. Bill Melms of the Marshfield Clinic and athletic trainer Jon Coniglio.
"Thank goodness for Dr. Melms and Jon," Knautz said. "They are really hands-on and do a lot of work with us to educate and help determine where the kids are at."
While the clearance and restrictions are up to the student's primary care physician, Knautz said Dr. Melms and Coniglio provide valuable insight.
All that combines to make sure that students, who are still experiencing symptoms are not put back on the field before they are ready.
"Any student that is still symptomatic will never be released to play," she said. "If they still have headaches or other symptoms, they will be retested until they are cleared."
With the team in place at the school, Knautz said the next step is to let parents and students know all the services that are available to them.
"Any sports sign-up day, Dr. Melms and Jon are at a table to introduce themselves," Knautz said. "I am going to be there, too. The parents need to see me, Dr. Melms and Jon and have this explained to them. That we are there for their student if they need help."
For Knautz, this is her first year as school nurse at Lakeland Union High School and she said she was surprised at the number of concussions.
"Concussion awareness is a new thing and last year there wasn't the management that there is now," Knautz said. "I was pretty amazed when the kids started coming. But I am happy the kids are good about coming in and letting me know when something is wrong."
Bryan Rose may be reached via email at email@example.com.
Concussions always on the minds of Lakeland coaches
With the injury making headlines, T-Birds focus on prevention
By Bryan Rose
of The Lakeland Times
One can hardly sit through a sports news program, a game or even a nightly newscast without the issues of concussions being raised.
With better diagnosis and with the damage it causes later in life becoming more apparent, concussions are the issue everyone is talking about when it comes to sports.
Legislation has been passed, new techniques are implemented and better education is being provided for parents, coaches and players.
And in the middle of that whirlwind of concern are high school football teams and Lakeland Union High School is no different.
"Concussion awareness has been stepped up a lot here in the last couple of years," Lakeland football coach Mike Mestelle said. "We have tried to make it a priority that the safety of the athletes comes first."
To that end, Lakeland appears to be ahead of the curve when it comes to concussion awareness and prevention.
A piece of legistlation recently passed in Madison requires all schools to educate parents and players about concussions and set up protcols for when players can return to the field.
Lakeland already has those systems in place, according to Mestelle.
"First of all every athlete does this at the beginning of their sports career regardless of sport, they take a test called the impact test," he said.
The test measures brain function through a series of stimuli and questions that test thinking skills and reflexes.
"The test is administered by our trainer and it is computerized," Mestelle said. "If there is an injury or a suspected concussion, then the athlete is tested again and they can compare the results."
If a player is diagnosed with a concussion, they must first have all their test readings return to normal before they can return to the field of play.
It is those types of improvements in diagonsis and treatment that Mestelle said is the reason for the increased awareness.
Mestelle has been aroung the game of football since grade school and said the medical community has made great strides in terms of recognizing concussions.
"Even a few years ago, you didn't worry about that," he said. "It wasn't common and you didn't worry about it. Now it is common and you have to worry about it."
That means relying on the training staff to let the coaches know they suspect a possible concussion.
The medical people are key there," Mestelle said. "We always have a trainer and a doctor at every game. We are fortunate in our community with our training faciliities and the support we have."
It is also key because the symptoms of a concussion may not be apparent to non-medical professionals.
"We have had times before where a kid takes a hit in the game and it could have been in the first quarter," Mestelle said. "At halftime, the trainer came up and said the kid can't go back in. I said 'Really when did that happen?' The kid didn't have any outward symptoms."
In addition to not having outward symptoms at the time, concussions can come about without taking a big hit.
"We think we did have one concussion last year where it wasn't a hard hit but the accumulating effects of hits over the course of the week," Mestelle said. "That is kind of a new one that we haven't been aware of."
Mestelle said the player notied difficulty in class.
"He was having trouble reading because he couldn't focus," the coach said.
Mestelle said with concussion symptoms difficult to detect from the outside, the school is educating players that if something is not right, they need to seek help.
"We tell them if something is not right, go see the trainer," he said. "The earlier they can get there, the better it is."
While the coaching staff is working with players on what to do if they have a concussion, they are also working on ways to help prevent concussions.
"We have upgraded our helmets considerably in the last year," Mestelle said. "Helmets are quite expensive, we can't afford to throw out all our old helmets and start with brand new ones. But the helmet manufacturers are very aware of concussions and they are coming out now with helmets that are rated safer for concussions."
Last year, Lakeland purchased 15 Riddell Revolution Speed helmets, rated five stars for anti-concussion, and the booster club purchased five helmets.
"It cost them over $1,000 for those five helmets," Mestelle said. "Sometimes that booster money buys some of the bells and whistles that you don't normally get. So we are taking that money and putting it into the safety of our athletes."
This offseason, the school will purchase 12 more of the helmets and the boosters will purchase another five, giving Lakeland a total of 37 helmets.
"Over the couse of the next couple of years, we will have all of our players in these helmets," Mestelle said.
The first batch of helmets will go to players of positions that are more prone to concussions.
"Our quarterbacks, running backs and linebackers, that's who you think are going to get the hardest hits," Mestelle said. "Outside of those positions, we had those helmets on kids that have had concussions before."
While the team is improving their gear, they are also educating players on how to maintain their equipment for optimum protection.
"These helmets have an air bladder inside that redirects the contact," Mestelle said. "Through the course of the season, the air pressure does change. Weather, taking hits, can take some air out of the helmet and have it not fitting right. We have them check their helmets every Thursday to make sure it is fitting right."
So far it seems like the steps Lakeland is taking are working.
"We had three concussions last season," Mestelle said. "That is down considerably from the year before."
Bryan Rose may be reached via email at firstname.lastname@example.org.
If Lakeland Union High School football coach Mike Mestelle had his way, he would have 11 starters on offense and 11 different starters on defense when the Thunderbirds take the field.
"One of our goals is that we want to play as many kids as possible," Mestelle said. "For one thing, it is a lot more fun for the players. Players don't come out to sit on the bench, they come out to play. That being said, there is some preparation that has to be done before a kid is ready to play."
Still, Lakeland has never had more than six players play both ways and that number is usually closer to two or three per year, Mestelle said.
So when the Minocqua-Hazelhurst-Lake Tomahawk (MHLT) school board holds a special session Monday night to decide whether or not to consolidate its football program with Arbor Vitae-Woodruff (AV-W), it could come down to numbers.
Both elementary schools are looking at reduced numbers in their seventh and eighth grade football programs to the point where the majority of players could play offense and defense the entire game.
The danger in that is more contact and a greater risk of concussions.
"We had one concussion last year where it wasn't a big hit, but the accumulations of hits throughout the week," Mestelle said. "Those are the scariest to me. If a kid gets a hard hit, you know how it happened, but those accumulated ones are different."
It's different because it relies on the student-athlete to recognize the signs and report to the training staff.
"The player came in with Dr. [Bill] Melms and they told us he has a concussion that he couldn't play," Mestelle said. "He was taking a biology test and the words went blurry."
It is those types of concussions that have some worried if the elementary schools don't combine, players could be a risk.
Still Mestelle and the high school fall short of demanding the schools combine.
"We can't go into the elementary schools and tell them 'you will follow this plan,'" Lakeland athletic director Justin Szews said. "But we can show them what we do and tell them if you want help with it or if you want to share some of this we will. I don't feel like cramming anything down the throats of anyone who doesn't want it."
And what the high school could share is a concussion plan and practice techniques that help limit contact in practice and provide support for players who have been injured.
"The [concussion] program that we use is provided by [athletic trainer] Jon Coniglio and our medical staff," Szews said. "If a student is diagnosed, they fall into the flow chart."
With the system, Lakeland is ahead of some schools in the state.
"I feel like we are a little bit ahead of the curve here," Szews said. "Now at the state level, they are talking that maybe every school should have baseline tests. Well, we have had one since 2009."
Another area where the high school is limiting contact is in its football practices.
"We do take precautions," Mestelle said. "In our tackling circuits, we use crash pads and hand shields. We do 'thud' sessions where you have live contact until the whistle blows. We have been doing that for 15 years."
Mestelle said the high school also reaches younger kids during their football camps over the summer.
"We run youth camps for kids as young as fifth grade," he said. "We do tackling sessions and in those sessions, we go through form tackling, straight on tackling and more game tackling. We don't teach them to strike with the face mask. We have always been a slide your head to the side team."
Mestelle said the camps are not just for the students but are open to coaches as well.
"Our camps are open to the youth coaches and the youth coaches have always been invited to our camps and see how things are done at the high school level," the coach said.
But Mestelle said he does not dictate what each coach must do with his own program due to the separate nature of the area.
"We have a little more difficulty getting on the same page with every school having its own district," Mestelle said. "Every school has its own school board and with these types of issues, it is a little more difficult."
It's so difficult that Mestelle does not tell coaches which offenses and defenses they need to run.
"I have not talked to our grade school coaches about what offense and defense they are running or any of those things," he said. "Maybe at some point that will happen. We haven't mandated anything nor would I see that for the foreseeable future."
And if faced with the choice, Mestelle said he would let his son play football at the middle school level whether the teams combine or not.
"Certainly I know concussions are a concern," Mestelle said. "If my son were starting youth football now as a youngster would I be concerned, probably. But I still believe football can be a safe sport, it is a good sport and teaches a lot of good life lessons."
Mestelle also praised the staffs of the youth programs as another reason he would let his son play.
"I am confident that we have good youth coaches and good people on board there that are doing safe things," he said. "I would not be opposed to being more involved in teaching safety techniques and safety things. But I think we have a good program down to the third grade level and I think the progression works well. And has been successful in the past."
Bryan Rose may be reached via email at email@example.com.