High School Ahead on Concussions

In the sporting world this past fall, concussions served as a hot topic.

It's nothing new for Ridgewood High School. Over the past several years, the athletic staff has made concussion awareness, detection and recovery a linchpin of its sports medicine program.

"We're trying to get rid of the warrior mentality," athletic trainer Nick Nicholaides said. "It's one thing with an ankle sprain or muscular-skeletal injury, but with the brain... nothing's mild."

A University of Pittsburgh alum, Nicholaides implemented his alma mater's ImPACT testing system—also used by the National Football League—to track and protect his athletes.

Previously, most schools relied on subjective methods to deem when athletes could return to action. With advanced technology and research available on concussions, it's new ball game.

"Now, whoever takes you off, puts you back in," athletic director Greg McDonald said. "Whether that's a doctor or Nick, or whatever. Sometimes it's difficult, but this is more about these kids' futures than a game."

With the ImPACT testing, Nicholaides now effectively manages the 1,100-student athletes competing at Ridgewood through three seasons.

Prior to each season for "contact/collision" sports, Nicholaides tests athletes to achieve a baseline score. Tracking measurable cognitive behaviors like design memory, word memory, symbol recognition, and reaction time, Nicholaides catalogues how an individual should place. 

Later, if a concussion occurs, an athlete must exhibit baseline scores before he or she can begin training again.

Nicholaides monitors the testing and can tell when someone is trying to cheat it. For the most part, he hasn't had to confront too many deceptive test takers.

After returning to a baseline score, athletes must remain asymptomatic at rest and in exertion, and have written clearance from their primary care physician or specialist to play.

In addition to added protections following concussions, the school has taken a proactive stance on awareness.

Nicholaides pointed to education to protect against long-term injuries. "We tell them 'this is what could happen. You can trade one game in for the whole season.' We're stressing it to coaches and athletes."

According to Ridgewood Sports Medicine's concussion protocol (available on the school's Web site), coaches are directed to follow the three 3's: recognize, remove, and refer.

Coaches now:

• Can identify symptoms (sensitivity to light, memory loss, headaches, balance problems, among many others); 
• Are taught to remove athletes from games; 
• And immediately refer players to a primary care physician or hospital.

At Ridgewood, the sports most effected are surprising, McDonald said. Cheerleading—primarily because of whiplash—and soccer, specifically girls, rank at the top above football, hockey and basketball.

In general, Nicholaides said seven to 10 days away from action should help a simple concussion, with 10 days to two weeks needed for a complex one. McDonald noted because teenagers are still growing, they need longer recovery times than adults.

"Heck, some of these kids still have soft spots on their heads," he said.

A leader among state schools, Ridgewood has fielded requests to demonstrate its system to other schools. And as concussion information continues to grow, Ridgewood plans to be ahead of the curve.