Specialists Step Up Concussion Study As Players Ready To Hit Soccer Pitch Under New Head Rules

By Cheryl Conway

Soccer season will be kicking in again soon and with that more cases of kids getting hit with head injuries due to heading the ball, running into posts or even another player.

Measures have been taken by the United States Soccer Federation to create a policy to limit head balls by youth players. The new guidelines which may begin in the fall of 2016 are expected to prohibit players 10 years old and younger from heading the ball. The regulations also aim at reducing headers in practice for players who are between the ages of 11 and 13.

Soccer organizations are not alone in taking initiatives when it comes to concussion, whether it involves minimizing or placing greater awareness on the impact a concussion can have on an individual, especially if the brain is not allowed enough time to rest.

Dr. Catherine Mazzola, the director of Pediatric Neurological Surgery at Morristown Medical Center and Dr. Richard Servatius at the Rutgers’ Stress and Motivated Behavior Institute (SMBI) are conducting a study to understand how head injury affects brain functions such as attention, learning and memory.

“Every year we see hundreds of kids with traumatic brain injury (TBI),” says Mazzola, who has been treating children with TBI since 1995.

Several young patients have come in to Mazzola’s care that were concussed from heading a soccer ball or injured during the game. Restricting head balls to younger players may protect those young brains, she agrees.

“I think that’s a good thing,” says Mazzola. “You only have one brain; it’s a good idea to take care of that brain.”

The safety initiatives were brought on as a resolution from a class-action lawsuit filed by parents and players in 2014 against U.S. Soccer, FIFA and the American Youth Soccer Organization regarding negligence in treating and monitoring head injuries sustained from playing soccer.

According to that case, nearly 50,000 high school soccer players sustained concussions in 2010- more players than in baseball, basketball, softball and wrestling combined, according to a New York Times article.

“That kind of contact with a ball can do damage to the brain tissue,” says Mazzola, and may only be apparent on a microscopic level.

One of the main obstacles in dealing with concussion is that doctors can not diagnose a concussion based on a catscan or MRI, says Mazzola. A person may have no signs of a fracture or bleeding, but that does not mean a child’s brain has not suffered an injury.

Mazzola says more attention has been given on the issue of concussion than it has in the past based on more studies on the impact that concussion can have on a person’s brain, especially when not given enough time to heal or rest.

“We didn’t realize how much damage is done when you have multiple concussions,” says Mazzola. “We have more awareness of long-term effects of concussion.” A child with a concussion will almost show signs of slow processing. After time their cognitive performance will function.

“We’ve realized how important and damaging, how repetitive or mild, brain damage is on the young brain,” she explains. “Mild brain injury can affect that child’s cognitive long-term outcome. The younger the child, the more vulnerable because the brain is not fully developed yet.”

Younger children who head a soccer ball also have neck muscles not as strong as older children and can therefore face some whiplash, she adds.

“The younger they are the more they are at risk for injury,” says Mazzola, co-founder of the New Jersey Concussion Center.

With the implementation of the ImPACT Test, a mini IQ test that can be taken online to measure a person’s performance in certain areas – such as visual memory, auditory performance, accuracy and speed of processing information- specialists are more accurately able to realize if a person’s brain is healed enough to return to an activity.

All high school athletes are required to complete an ImPACT test online, usually before their season begins so if someone gets a concussion while playing a school sport they can retake the test and measure any improvement over time. Players are not supposed to return to play “until previous score is within 10 points from baseline,” explains Mazzola.

“It’s a timed test,” Mazzola explains. “You can see sometimes that people have a problem with visual learning,” or verbal skills, reaction time can be slower. Then in two months, when they retake the test, the individual may improve.

Five to ten percent of kids do not get better after concussion, Mazzola says, and therefore need cognitive remediation, which requires them so seek a specialist for monitored care. Students can experience learning problems after faced with a concussion, especially if the brain is not given enough time to heal.

“There is a period of rest and rehabilitation for those with concussion,” says Mazzola. That message needs to get out to teachers, parents and coaches that these individuals need to be given adequate time to rest.

“You have to give your body and brain time to heal,” says Mazzola. “Coaches would say ‘you just got dinged,’ but people are really realizing that even mild brain injury is important. It’s just as important as having an ankle injury or arm injury.

“They may look alright but they may not be acting alright,” she continues. “When in doubt sit them out,” and have them be seen by a medical doctor or concussion specialist. “If you have any question, best thing is to pull them out and let them rest no matter what you do.”

Putting a child back in a game puts the player at risk of having a “second impact injury” which “can be lethal” in some cases, says Mazzola.

To measure when a child is ready to go back into a game, players must complete a Return To Play (RTP) protocol to make sure their balance and coordination are up to par; that they are cognitively performing well, brain is performing well; and to make sure they are headache free, she says.

Some students, however, do not play a sport and may miss the opportunity of having a baseline ImPACT Test conducted. Mazzola is offering this supervised timed test for free through her office at the NJ Pediatric Neuroscience Institute for any child who has had a concussion within the past six months.

Testing began in July 2014 and will continue through Nov. 2016. The approved study will then be used to determine how quickly children recover from concussion and how their response time improves after concussion.

Participants can also get a copy of their test results to share evaluations with teachers and coaches so they can understand if a child needs more time for brain rest.

Anyone interested in participating in the Rutgers Concussion Study and wants a free ImPACT Test, should call Mazzola’s office at 973-326-9000. The test is being offered to youth between the ages of 11 and 18.

For more information on concussion, go to www.njconucssioncenter.com