Author: Terl, Matt
Date published: December 1, 2011
when Shane caswell was a high school hockey player in upstate New York, a dirty hit put him headfi rst into the boards, knocking him out. He quickly regained consciousness and skated off to the bench.
"When I went back to the bench, I got very emotional," Caswell says now. "I was crying, I was swearing, which aren't normal behaviors for me. And in retrospect, I couldn't see and was having visual disturbances."
Today, these symptoms would immediately indicate concussion. In 1991, Caswell's coach put him back into the game almost immediately, only taking him out when it was clear that his disorientation was severe enough that he couldn't contribute.
"There was no medical care," Caswell says, "and really no understanding at the time of what a concussion was."
Caswell was fortunate and escaped with no ill effects, but the incident haunted him. Which is part of how he wound up as Dr. Caswell, in charge of the Sports Medicine Assessment Research and Testing (SMART) Laboratory at George Mason University, a multi-disciplinary sports medicine lab focused on injury prevention and human performance. One of Caswell's specialties is, of course, concussions.
It's a lively fi eld to be involved in at the moment, at all levels of sport. Professional sports leagues have made strides to improve concussion awareness and regulate return to play. High schools have followed suit-and, increasingly, parks and recreation agencies are also getting involved in testing and concussion safety. Recently, for example, the Franklin Lakes (New Jersey) Recreation and Parks Department mandated cognitive baseline testing for athletes participating in their programs and facilities.
Cognitive baseline tests are used to detect subtle changes in the way information is processed by someone who has suffered a concussion. The test is fi rst taken while healthy, establishing a baseline, and administered again as one of the fi nal steps in determining when someone is no longer suffering a concussion's effects.
As public concern over concussions grows, other parks and recreation administrators and staffers might naturally be inclined to follow Franklin Lakes' lead.
Which might not be the best idea.
"These exams are a tool," Caswell explains. "They are designed to be used by a qualifi ed and well-trained healthcare professional who understands concussions. They're really not intended to be used by untrained and unqualifi ed nonmedical professionals, such as coaches, parents, and administrators."
James Kozlowski, an attorney specializing in the legal aspects of parks and recreation administration (and a regular Parks & Recreation contributor), agrees. "Right now I don't think it is the community's responsibility for doing it," Kozlowski says. "Just because some people are doing it doesn't mean you're negligent for not doing it."
In fact, Kozlowski explains, adding this requirement might open parks and rec agencies to more liability rather than less.
"In this whole area oftentimes less is more," he says. "At this point in time, there's no requirement that that be done. But if you assume that you're going to do it, you'd better do it right."
The popularity of cognitive baseline tests (ImPACT being the best-known brand) stems partly from their use on the professional level. But even NFL athletic trainers express skepticism that these tests are the best way to help younger athletes.
According to Larry Hess, head athletic trainer for the Washington Redskins, "The biggest thing now is heightened awareness. There's more awareness of the signs and symptoms and more education, and I think that's what we have to get across to the youth athletes and the people that are around them every day."
Again, Caswell agrees. SMART Lab has partnered with Central Loudoun (Virginia) Youth Football, a nonprofi t league for ages 6-14 that uses municipal fi elds, and implemented a more holistic approach to concussions and sports injuries. The league maintains a safety commissioner, handling general league safety procedures, and has entered into an affiliate agreement with George Mason University, paying a portion of the tuition for one of Caswell's graduate assistants-a Certifi ed Athletic Trainer-to serve as the medical authority at nearly all of their league games.
"There are multiple benefi ts ," league president Roly Rigual explains. "Not only do we get the benefi t and security of having a medically trained person at these contact games in case something really bad happens, but we're collecting data," which will be used in the future to identify trends and minimize risks.
Caswell has helped the league set up an online injury monitoring system, even tracking injuries incurred in practice. He has also provided mandatory coaching safety training, which he believes is the most important element parks and rec staffs can offer to their leagues and athletes. Specifi cally, Caswell believes that annual safety education sessions should be mandatory for coaches.
"Annual because the science is continually changing, particularly with regard to concussions," Caswell says.
One place where the education approach has worked well is the Newtown Township (Pennsylvania) Parks and Recreation department, which in September partnered with Princeton Brain and Spine Care (PBSC) for a Concussion and Brain Injury Symposium.
Dr. Nirav Shah, a neurosurgeon and head of the Concussion Clinic at PBSC, helped to spearhead the event.
"One key resource that was very important was the parks and recreation department," Shah explains. "What they were able to do was get the word out to the parents, to the children, to get us in front of the local youth leagues, and really galvanize interest in the community- which is the most important thing you need for something like this."
The event was targeted at coaches, medical professionals, and parents of young athletes, and featured a roundtable discussion, a Q&A session, and a concussion care expo.
Newtown parks director Kathy Pawlenko judged the event a tremendous success. "I was so proud to be a part of this," Pawlenko says. "It's really raised the awareness in our community."
In the end, though, the education begins with one simple phrase: "Err on the side of caution," Caswell says.
Everyone around the league should be made aware of the classic symptoms of concussion; CDC offers free kits, training, posters, and more through its Heads Up program, which is an excellent place for parks and rec administrators to start, even if connecting with local medical professionals and organizing symposia is impractical.
Being let back out on the ice with a concussion wound up okay for Dr. Shane Caswell, but there is no reason that any modern athlete should face that kind of risk today.
MAtt teRL is a freelance writer living in Northern Virginia with a specialty in sports.