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Team effort helps athletes return from concussions

State law requires all Illinois High School Association (IHSA) member schools to adopt policies regarding head injury and concussion. Any athlete who is suspected of
sustaining a concussion or head injury must be removed from competition. That athlete cannot return to practice or competition without written clearance from a physician or a certified athletic trainer working with a physician.

To support the needs of high school and college athletes in the Chicago area, Loyola has created a rapid response team of specialists from sports medicine, neurology and neuropsychology, all of whom are trained to treat and manage head injuries. They collaborate with neurosurgeons on there are cases involving structural damage, and with physical therapists for managing prolonged symptoms.

“The initial evaluation determines if the athlete has a serious neurologic problem that would require hospitalization or prompt surgical evaluation,” said Matthew McCoyd, MD, assistant professor, neurology, Loyola University Chicago Stritch School of Medicine.

“We’re most concerned about a structural injury to the brain, neck or spinal cord, but these are quite rare. If the pupils don’t look right, if extremities are not moving properly, or if concentration or language are altered, we might recommend an evaluation at the hospital, including imaging with CT or MRI scans,” Dr. McCoyd added.

“Other neurological examinations are also important as concussion-related brain injury likely occurs at a cellular level and is therefore “invisible” on CT or MRI scans,” explained Dr. McCoyd. “We immediately establish a baseline for the patient though a combination of tests, which may include written questions and answers and computer-based tests to assess the patient’s ability to think and react, determine a patient’s cognitive aptitude.” said Neeru Jayanthi, MD, medical director, Primary Care Sports Medicine, Loyola University Health System.

Once the examinations are complete and the patient is free of symptoms, a Loyola team member will conduct more assessments to confirm that there are no subtle problems with memory or concentration. For athletes diagnosed with prolonged post-concussive symptoms, Loyola’s team offers innovative protocols to help patients return to play. Once it’s deemed safe for the patient to compete again, the physician provides the necessary written clearance.

“Our goal is to get the athlete back on the field as quickly as possible, but as safely as possible. We coordinate care with the school’s athletic trainers. Most athletes can return in seven to 10 days without any longterm consequences,” Dr. Jayanthi said.

Jill Adams McDonough, a mother of three student-athletes, is grateful for Loyola’s team approach that helped her eldest son, Ryan. After experiencing two previous concussions while playing basketball and lacrosse, Ryan suffered his third head injury on the soccer field as a junior at York High School in Elmhurst.

“Ryan’s head collided with another player’s head. When he started losing his balance, his coach took him out of the game,” Jill remembered. “Ryan told us he thought he had another concussion. He was sensitive to noise and light, and he had trouble sleeping.” Jill took him to Loyola.

“Our concern was that Ryan was still having symptoms weeks after his injury,” Dr. McCoyd said. “The long-term consequences of one or two concussions is not clear, but we do know that repetitive head trauma can cause long-lasting neurologic injury.” “Our biggest role is educational. We help athletes develop a plan to reach their shortand long-term goals,” Dr. Jayanthi said.

“We spend time getting to know the patient and family, and then we explain all the risks so that they can make the decision that’s best for them.” “The doctors were fantastic,” Jill said. “They had deep knowledge and experience based on the latest studies, they answered all of our questions, and they asked Ryan questions about his needs and goals. They spoke Ryan’s language. They presented treatment options and asked him to make a wellconsidered decision.”

After weighing the risks and his options, Ryan chose to stop playing soccer. Instead, he became the varsity team manager so that he could continue to be a part of the game and social circle he enjoyed.

Ryan was among the minority of athletes who choose to stop competing. “Most student-athletes return to their sports,” Dr. Jayanthi said. “It’s unusual for us to suggest a youth retire from sports due to head-related injuries, but we won’t hesitate to outline the risks of a young athlete who may need to consider that.”

“There’s a r isk that athletes won’t repor t their symptoms if they think there will be a long delay before they can compete again,” Dr. McCoyd said. “If athletic trainers, coaches or physicians suspect a concussion, they can call (708) 216-GAME (4263) to have the athlete seen by our concussion program physician within 24 to 48 hours.”