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Uploaded on Jun 14, 2011
Kristin Wheeler, 17, president of her junior class and a varsity cheerleader for Swampscott High School, would seem to be an unlikely candidate for a concussion, but she's already suffered two—the last of which required six weeks for recovery. Today's cheerleaders do more than stand on the sidelines. They tumble, flip, dance and perform stunts requiring them to be thrown into the air to execute a twist or split. This increased athleticism and showmanship also puts them into surprising category—alongside football, hockey and soccer—as athletes more likely to receive a concussion.
Five of the 20 cheerleaders on Wheeler's team were diagnosed with concussions during the Fall 2010 season. Concern about concussions has received increasing media and public attention over the past few years as new research has shown the long-term effects that multiple concussions have on the brain, including changes in personality or mood, anxiety, depression, cognitive and memory problems, and even dementia from chronic traumatic encephalopathy (CTE).
In a 2009 study, 18 percent of Massachusetts students reported a head injury in the previous year. In response to this, Massachusetts enacted new rules in June 2011, that require middle and high school athletes suspected of having a head injury or concussion to be removed immediately from practice or competition and be barred from returning to play the same day. They must be cleared by a physician or a certified medical professional and have a "graduated reentry plan" before returning to the classroom or field. In addition, coaches, parents and students are required to receive training to recognize the symptoms of concussion.
For Wheeler, pre-season testing and concussion awareness, helped her recognize that she might have suffered a concussion. This past September, while practicing stunts with her team, Wheeler was hit repeatedly in the head while catching another cheerleader.
"After the last hit, I stepped out and started crying because I couldn't take it anymore. Instantly, I had a really bad headache, felt nauseous, foggy, and was just out of it," said Wheeler. She took some ibuprofen, but the headache continued. "As soon as I heard her symptoms, we went straight to the pediatric emergency room at MassGeneral for Children at North Shore Medical Center," said Joanne Wheeler, Kristin's mother.
Kristin was diagnosed with a concussion and referred to NSMC pediatrician Donald McAuliffe, M.D., who is experienced in concussion management. "I initially laughed when Dr. McAuliffe told me to just lie down and rest in a quiet place," said Wheeler. "I'm usually always on the go and I didn't think a concussion could shut me down. But Dr. McAuliffe was right; I just couldn't stand the noise and the constant pounding in my head and I had to rest in my room with the lights off. I couldn't even read a paragraph without feeling enormous strain."
"The most important part of treating a concussion is to give the brain time to heal without risk of further physical trauma or even the cognitive strain of learning or concentrating too hard," said Dr. McAuliffe. "If an athlete broke a leg, they wouldn't put pressure on the injury for a couple of weeks. It's the same with the brain; it doesn't heal overnight. Why risk further damage by rushing back before it's fully healed?" Navid Mahooti, M.D., an NSMC family medicine and sports medicine physician adds, "If an athlete goes back too early, they are more at risk to suffer an additional brain trauma leading to Second-Impact Sydrome, which could cause a cascade of dying brain cells."
To help physicians and coaches determine when the brain has healed and athletes can return to play, Swampscott instituted ImPACT (Immediate Post-Concussion Assessment and Cognitive Testing) testing in 2010. Students take a computerized test at the beginning of the season to measure verbal and visual memory, processing speed and reaction time. This baseline assessment helps to objectively evaluate the athlete's post-injury condition and track recovery for safe return to play, thus preventing the cumulative effects of concussion.
Wheeler was allowed to return to school after a week, but her headache and other symptoms persisted. "Just the noise of pushing in of chairs would cause an awful headache. Because I didn't have any outward signs or bruises, I had to remind my teachers that I had a concussion, so they could give me extra time to complete an assignment or test," said Wheeler. "It was frustrating because I wanted to get back to normal and to cheering. I couldn't even go to the games because it was too loud."
After repeating the ImPACT test for six weeks, Dr. McAuliffe determined that her brain had finally healed and cleared her to return to cheering. "If we hadn't had the ImPACT test, I'm sure Kristin would have gone back to cheering too soon and I don't like to think about what could have happened if she got hurt again," said Joanne Wheeler.