In a joint project of Georgia Southern University’s School of Health and Kinesiology, the Statesboro-Bulloch Parks and Recreation Department and Clark Medical Group, about 50 children ages 5 to 17 have recently undergone baseline screenings that could help if they experience concussions.
Children as young as 7 already play contact football, which includes tackling, through Parks & Recreation programs.
“This is actually my first time playing,” said Joseph Hendrix, 8.
So the Julia P. Bryant Elementary School second-grader came to the Clark Medical Group clinic on Brampton Avenue with his parents, Matthew and Heather Hendrix, after hours on Aug. 8 for his screening.
“It’s a little bit of a concern, which is why we want to have him screened beforehand, just to monitor things,” said Joseph’s mom. “I think I’m a little bit more worried about it.”
His dad agreed, “Yes, she’s the worrier.”
After Assistant Professor Nicholas Murray, Ph.D., Georgia Southern’s director of concussion research, briefly explained the screening procedures, Joseph and his parents went to an exam room. Kristen Neitz, a certified athletic trainer in addition to being a graduate research assistant from the GS Concussion Research Lab, talked in a friendly way to Joseph and started asking him a series of questions.
SAC and ImPACT
Then he was asked to recite an ordered series of numbers. Neitz also asked him to repeat a list of words, such as monkey, lemon, sandwich and saddle. Several minutes later, after completing other parts of the screening, Joseph was asked whether certain words were or were not part of that list.
These memory and concentration tests are elements of the Standardized Assessment of Concussion, or SAC, a procedure simple enough to be used by parents, Murray said. It also includes questions about symptoms, and athletic trainers and coaches use it as an immediate test on the sidelines. But it was just one of four tests given young athletes during the baseline screening.
In a more complex test, Joseph had to choose colors on an iPad in the order in which they first appeared. Then he matched cards on the screen after they flipped to reveal colorful objects for only a moment. These resemble the games Simon and Concentration, but they’re actually part of the Immediate Post-Concussion Assessment and Cognitive Test, trademarked as ImPACT.
In addition to this cognitive screening, the researchers administer a balance test and a vision test. For the balance test, Cody Grotewald, an athletic trainer and previous graduate, asked Joseph to take a few steps forward, one foot behind the other, with his eyes closed. For all but the youngest children, standing on one foot is also used to test balance, and for teens and older individuals a pad is placed on the floor.
Eye tracking, how the eyes move when following an object, is the main part of the vision test.
Although these same procedures can be used to check for symptoms, the purpose of this screening project is not to discover concussions. As baseline screening, it is intended to show what is normal for the individual, to provide a basis for comparison in case a concussion occurs later.
Finding a baseline
“So essentially it’s not for us to screen out to say, ‘Do you have an existing concussion?’ This is a starting point for us to use if they do get a concussion injury,” Murray said.
Starting with an individual baseline provides “the highest level of evidence” to guide the best available care, he said. Existing conditions, such as attention deficit disorder or a vision problem, can otherwise produce misleading results when a test is used after an injury.
“Without this information, if they do have a concussion injury, it’s very hard for a physician to manage the recovery process without these data points that tell them the original state of the athlete,” Murray said.
Besides providing clinic space for the screenings, Clark Medical Group, led by Aaron Taylor Clark, M.D. and Iris K. Clark, M.D., have been active donors to the research program, Murray said. If the screening results did suggest that someone had a concussion and that person did not have another physician, the medical group’s doctors would be available for diagnosis and treatment, he said.
On seven evenings over the course of three recent weeks, the team faculty members and graduate research assistants who work in the School of Health and Kinesiology’s Concussion Lab provided the free screenings at Clark Medical.
“This is also great hands-on practical testing for our students so they can learn again how to administer these tests in appropriate fashion,” Murray said.
The graduate research assistants and other students involved have all trained previously at the lab.
The joint project, directed by Murray and Associate Professor Barry Munkasy, Ph.D., is an extension of the research done at the Concussion Research Lab in the Hanner Complex.
Murray and Munkasy’s specific discipline is biomechanics, but faculty members from other kinesiology disciplines are also involved in the work.
By working with Statesboro Bulloch Parks and Recreation and Clark Medical, Georgia Southern’s lab also provided a service to the community, Murray said.
More than 35 young athletes were screened in those seven evenings, and another 15 to 20 were scheduled for screenings in the lab at Hanner, outside of the open clinic hours. Most, but not all, of those who have been or will be screened play Parks and Recreation sports.
“We’re trying to engage the fall sports first, those that are going to be the football, the soccer, those that have the highest risks, wrestling, those types of sports that are going to be engaging in one-on-one interactions with another player,” Murray said. “That’s where the risk of concussion seems to skyrocket.”
Although much of the national attention has been on the detrimental effects of repeated head injuries in football, particularly with NFL players, concussions occur to participants in all of these sports, he noted. At the lab, where staff members regularly work with people experiencing the effects of concussions, cheerleaders turn up almost but not quite as often as football players, he said.
Parks & Rec involvement
The Statesboro Bulloch Parks and Recreation Department staff distributed information about the screening to participants in “every program: tennis, golf, soccer, volleyball, cheerleading,” even archery, said Superintendent of Athletics Darryl Hopkins. Notices were placed on program receipts, in information packets for parents and on social media.
The department has included Centers for Disease Control and Prevention fact sheets about concussions, including signs to look for, in parent packets for the past seven or eight years, he said.
More recently, the Georgia Recreation and Parks Association requires that this information be provided to athletes participating in GRPA-sanctioned events, such as those for all-star teams, he noted.
“With concussions, there needs to be more understanding for people on both sides of it, and the more we can put that information out, the better off it can be,” Hopkins said.
Parents who are afraid of concussions may decide to keep their children from participating, but he thinks better understanding will alleviate some fears, he said. People can get a concussion from virtually any sport or from injuries that are not related to sports, Hopkins noted, and also said that youth sports safety equipment, such as football helmets, is being continuously improved.
“Right now I think people are scared of concussions because there’s not that much understanding of it, and all you see about it is mostly the NFL, and those big guys generate a lot of force when they collide with each other, but it helps to know now, at a young age, where they can know what to do and what signs to look for. If something’s not right, act on it,” he said.
This is the first year that the recreation department has been involved in a screening program. It is purely voluntary, and with 50 young athletes tested, the researchers are far from reaching the potential demand. Parks and Rec enrolls about 1,000 youth in fall sports and an even larger number in spring sports, including baseball and softball, according to estimates Hopkins provided.
The frequency and effects of concussions in the youngest athletes is an area where little is known, Murray said.
“We know nothing in youth sports,” he said. “We really don’t know anything. I can name probably about two or three people across the country who study elementary sport-related concussions.”