“I felt the motion of moving, felt people occasionally touch my arms or move my legs, then the noise began to pour in. I heard voices, some I recognized and some I didn’t. The sound of one word pierced my ears; it stood out from all the others – hospital. It rang in my head as I felt myself slowly drift out. Then, all of my senses came rushing back, along with a searing pain in my head. My heart was pounding, yet my body felt numb as the pain took over. I heard the reassurance of a voice near saying, ‘It’s going to be ok, I’m right here,’ as everything went blank once again.”
Tests showed that the young athlete had suffered a severe concussion – an injury that resulted in five-months of severe almost-constant headaches, blurred vision, extreme sensitivity to light, lack of concentration, seizures and severe fatigue.
“The concussion brought on so much more than physical discomfort and change,” Rachel explained, adding that her straight A’s went to F’s and it was an effort to even get out of bed or hold a conversation. “I had to withdraw from everything I loved because my brain simply could not handle more than the very basics. It wasn’t long before depression set in.”
Getting well and back on the soccer field was a slow process but through Gwinnett Medical Center’s (GMC) Sports Medicine Program, Rachel was back on the field last spring.
But her story does not end there.
“This was actually the second concussion Rachel suffered,” said her mom Paige Havens adding that she had one in the spring of 2011. The pediatrician who checked her in the spring of 2011 said she would be fine.
“Bottom line, he didn’t have training on concussion protocol and since it was a mild concussion, not a lot attention was given to the healing process. They put her back on the field after a week. We now believe the second one was so bad because the first one hadn’t healed.
“As happened with Rachel, irreparable damage can be done when a concussion happens,” Havens added. “Rachel will have seizures all her life – so in May after twenty months of testing, we now know that she has permanent damage to the brain and it’s simply not safe for her to be out on the field. It’s very difficult for her to not play soccer, but it’s not worth the risk.”
Four to five million concussions occur annually with increases emerging among middle school athletes, according to ImPACT, an international concussion management organization whose computerized testing GMC (and several professional and college teams) uses to signal if the brain is not functioning right.
With statistics like that and the fact that thousands of children and young people are playing contact sports in Gwinnett, GMC has taken a huge step in working toward better diagnosis and treatment of concussion. As local schools and recreation programs return to the fields to practice for fall athletics, GMC is officially opening the Concussion Institute at GMC-Duluth, a facility that treats concussion and sports injuries under one roof.
The first of its kind in the southeast and one of only three of its kind across the nation, the Institute is based on a model that practices a multifaceted approach to concussion injuries and sports rehabilitation – all under one roof. That roof is a remodeled suite in the Hudgens Professional Building and features eight exam rooms, three therapy rooms and access to two physical therapy centers in the area.
Dr. Marla Shapiro, Ph.D., N.C.S.P, the new chief neuropsychologist at Gwinnett Medical Center-Duluth (GMC) in the Concussion Institute and one of only two in the state of Georgia explains that because concussion as such, is a highly individualized injury and because there are so many multifaceted symptoms with a concussion, the individual injured person can be much more effectively treated in one location.
“To be able to treat this multifaceted injury it is so helpful to not only have all the specialists at hand but you need to allow them to work collaboratively to treat the whole person,” Dr. Shapiro said. “We can treat the injured athlete or the individual with a concussion so much more effectively, so much more aggressively because we have all the resources in house.”
As a licensed psychologist specializing in developmental neuropsychology and concussion management and member of the multi-disciplinary Concussion Institute team, Dr. Shapiro oversees neurocognitive testing and provides care management and consultation, as well as community outreach and education.
Others on the team are Director Tim Simmons, MHA, ATC, LAT, Kristin Crea, manager, as well as a clinical education coordinator, an athletic trainer and a physical therapist. The physical therapist provides vestibular therapy and occupational therapy.
The Center has already received a “high-five” from Governor Nathan Deal. In a letter to the Concussion Institute at Gwinnett Medical Center–Duluth, Deal noted, “The Concussion Institute fills a vital need for the State of Georgia, creating a new continuum of care for athletes that experience concussions and serving as a valuable resource to their families.”
The Governor signed The Return to Play Act earlier this year, a law that includes developing return to play policies for young athletes who get a concussion and educating parents on the risks of concussions. (Click on the Heads Up Concussion in Sports Image to get the PDF)
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Background of Neuropsychology:
Neuropsychology is the study of brain-behavior relationships. Neuropsychological evaluations address skills within broad domains of functioning – including language, memory, attention, visual/perceptual, visual-motor, social-emotional and behavioral, and executive functioning – that can affect learning and performance. Functioning in one or more areas can be affected by environmental factors, such as the educational setting, as well as chronic and acute conditions such as concussions.
Background of Return to Play Act:
The Return to Play Act requires public and private schools which provide youth athletic activities to provide information to parents on the nature and risk of concussion and head injury and to establish concussion management and return to play policies; to require public recreation leagues to provide information to parents on the nature and risk of concussion and head injury; to provide for definitions; to provide for the endorsement of concussion recognition education courses; to provide for limited liability; to provide for related matters; to repeal conflicting laws; and for other purposes.
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Havens does not have enough praise for Gwinnett Medical Center and how after the second concussion their rehabilitation team worked with Rachel, her school, coaches and parents to hopefully get her healed and back on the field. But it went beyond the medical team at GMC.
“When we began to get ready to start testing her body’s ability to get back on the field we were thrilled to find that there was a certified athletic trainer at Rachel’s high school who works for GMC,” Havens said. The trainer and the doctor communicated about Rachel’s condition which Havens says was extremely comforting to her as a parent.
GMC’s Sports Medicine Program puts certified athletic trainers (ATCs) s) on the fields at several local public and private high schools at no cost to the schools or families of injured players.
The ATCs work closely with high school coaches and the Gwinnett Medical Center affiliated team physicians to prevent, manage and assess orthopedic or musculoskeletal injuries. As in Rachel’s case they facilitate access to medical care.
The GMC website states that the program delivers traditional sports medicine services under the direction of the Gwinnett Medical Center affiliated physicians. They also contract with private EMS and emergency transport, emergency action plans for athletic venues, access processes with the GMC emergency and imaging departments, and facilitate access to necessary support services.
If an athlete is hurt an ATC is at the school to work with them, give specialized care while communicating with their doctors, teacher and parents and help them know when and if it’s time to get back on the field.
“It’s helpful to the coaches, too because it takes pressure off them,” Havens said. “Rachel’s trainer helped her by communicating with doctors and reporting signs, symptoms and setbacks. She helped educate Rachel and by explaining symptoms to look for and would sometimes spot something before she did, such as when Rachel began stuttering and had to be pulled from play. She also communicated with me about what she was working on and what I should be looking for.
“What I’ve learned is that kids are playing sports at younger ages and it’s more competitive,” Havens said “It’s important that parents recognize the symptoms. Athletes also need to recognize symptoms and understand the need to tell if you get a hard hit. And their teammates need to watch also.”
As one of the community members who worked to help make the Concussion Institute a reality, Havens is excited that people who have brain injuries – from the middle school athlete to the victim of an auto accident or fall – will now have the best care available.
“Instead of each doctor working in a silo they work together and determine the best course of care. They will be working with the school system to help educate teachers on how to work cognitively with an injured child,” Havens said. “When a child is concussed school psychologists, counselors, the administration and teachers – all need to know what is going on so that all are working together.”
“They are doing it right,” said Dr. Shapiro. “This (the CI) was such a vision…what the staff have already accomplished I think is so impressive. And to truly have a multifaceted disciplinary collaborative clinic like this with the involvement and support of the community, it’s so exciting for me professionally to come to a place that’s really doing it so well.”
For more information visit
http://www.gwinnettsportsmed.com/concussion
Concussion Symptons and Risks:
http://www.gwinnettsportsmed.com/concussion-symptoms-and-risks
Two Simple Steps to Take the ImPACT Test
http://www.gwinnettsportsmed.com/impact
Download FREE Parents Guide to Concussion Care
http://www.gwinnettsportsmed.com/impact
For more information from the CDC visit: http://www.cdc.gov/Concussion
