Since Wisconsin’s concussion law, Act 172, went into effect in 2012, there has been much talk in the sports circles about concussions and safe return to play. Kathy Calkins, LAT, ATC, at Mercy Sports Medicine and Rehabilitation Center, answers four questions about sports concussions:
1. What exactly does the Wisconsin Concussion Law say?
The law states that every official, coach (paid and volunteer), parent, and athlete between the ages of 9 and 19 must receive education of concussions and the risks involved in participation every year. Each individual must sign an acknowledgement that they were educated.
Coaches and officials are required by law to immediately remove an individual from a youth athletic activity if symptoms indicate a possible concussion has been sustained.
Individuals suspected of having a concussion may only return to competition or practice after being evaluated by a trained health care provider. The health care provider is required to provide written clearance in order for the athlete to return to action.
The law also includes provisions to protect coaches, officials or volunteers from liability if they fail to remove an athlete from competition, unless there is gross negligence or gross misconduct.
2. Once an athlete has a note from a health care professional, are they OK to play in a game?
Leading sports medicine organizations have adopted a specific step-wise progression for return to play. This step-wise progression allows an athlete to increase activity intensity and duration, adding return to contact activities in practice near the end of the 5-step progression. The progression, which only begins after an athlete has been symptom-free with the aid of medication for 24 hours, is briefly outlined below. Athletes may progress one step below each day as long as they are symptom-free:
- Ten minutes of light exercise such as biking or light jogging
- Thirty minutes of non-contact sport specific activity
- Full duration of practice activity but no contact
- Full duration of practice/scrimmage with contact activity
- Return to competition
3. What is ImPACT testing?
Computerized cognitive testing is one tool in a health care professional’s toolbox to evaluate an athlete and determine their readiness to return to play. This additional tool provides for more consistent, objective and safer decisions about an injured athlete’s returning to play.
ImPACT (Immediate Post-Concussion Assessment and Cognitive Testing) testing is one brand name of neurocognitive testing. In about 30 minutes, this test measures an athlete’s memory, attention, brain processing speed, reaction time and post-concussive symptoms. Many high school athletes are baseline tested at their school by a licensed athletic trainer or school administrator. It provides a measure of how an athlete’s brain functions in a “normal”, uninjured state.
In the event that an athlete is concussed, a health care professional will evaluate the athlete. This evaluation consists of assessing the athlete’s subjective complaints, a physical assessment to include balance, reflexes, eye movement and control and a cognitive assessment. The cognitive assessment may be a pen and paper test or it may be a computerized test.
Post-injury testing is conducted by medical or appropriate health care professionals having specialized training and credentialing by ImPACT to interpret and evaluate test scores for deficiencies or abnormalities. These trained professionals will objectively base concussion management decisions and the decision for return to play on post-test comparisons, depending on when post-test scores return to baseline, among other clinical considerations.
4. My school does not offer ImPACT testing for my athlete, is there another way to get a baseline test?
Yes, Mercy Sports Medicine and Rehabilitation Center offers baseline testing for athletes who do not have access to testing at their school for only $20. Parents may schedule an appointment for their son or daughter age 9 and up, by calling (608) 754-6000.
Kathy Calkins works with the Janesville Jets hockey team and Craig High School athletics, Janesville. She is a member of the National Athletic Trainers’ Association, the Great Lakes Athletic Trainers’ Association, and the Wisconsin Athletic Trainers’ Association.