published Thursday, August 22nd, 2013

Cleaveland: Head injuries also hit cheerleaders

By Dr. Clif Cleaveland

From middle school onward, the routines of cheerleaders become progressively more complex. In high school and college, elaborate acrobatic maneuvers are often part of the routines.

Fans may think of cheerleaders primarily as entertainers, but demands of practice, conditioning, timing and execution of intricate programs rival those of any traditional athletic team. Girls represent the great majority of participants. More than 3.5 million American girls over age 6 participate in cheerleading, either as members of school-based squads or competitive teams.

Cheerleading carries with it a significant risk of injury, mostly muscular and skeletal. Head injuries, predominantly concussions, account for up to 6 percent of injuries. Risks of head injury increase with age of participants and complexity of routines. More serious head and spinal injuries occur at the college level. Most injuries happen during practices when routines are being perfected.

Concussions represent a disruption of normal brain function either by direct impact to the head or rapid deceleration of the brain within the rigid skull. Concussion may occur without a direct blow to the head. Symptoms may include unconsciousness of varying intervals, headache, dizziness, brief loss of memory, difficulty concentrating, disturbed sleep patterns and depressed mood. Many concussions go unreported or are not suspected by coaching staffs. Contrary to popular belief, most victims do not lose consciousness.

Return to activity before resolution of all symptoms of concussion may set the stage for an even more severe injury. Cheerleading accounts for more catastrophic injuries to brain and spinal cord than any other women’s sport, and recent concussion is a significant risk factor. It is important, therefore, to monitor closely the course of cheerleaders, or any athletes, who may have sustained concussions to assure that normal brain function has returned prior to the resumption of physical activity.

Self-reporting of symptoms is not dependable. Cheerleaders, like all athletes, are anxious to return to action and may minimize or be unaware of persistent symptoms.

Gary Solomon, Ph.D., from Vanderbilt’s Department of Neurological Surgery and Sports Concussion Center, co-authored with Mark Lovell, Ph.D., a study published online last week in the Journal of Pediatrics examining this issue. From a large database, they evaluated 138 middle and high school cheerleaders who had undergone computer-based, standardized testing of brain function before and within seven days after they had sustained concussions. The test employed was the Immediate Postconcussion Assessment and Cognitive Testing instrument, “ImPACT” (www.impacttest.com), which includes an inventory of symptoms and a detailed, computerized assessment of thought processes.

The researchers found that 37 percent of the injured cheerleaders, who reported no lingering symptoms post-injury, had measurable deficits in cognitive function.

In a phone conversation with Solomon last week. I learned that he directs post-concussion testing both for Vanderbilt Sports Medicine as well as the Tennessee Titans football team and the Nashville Predators hockey team. The presence at athletic contests of certified trainers is vital for prompt assessment of head injuries. Toward that end, Vanderbilt provides certified athletic trainers for 30 schools in Davidson and Williamson counties. The Vanderbilt group also provides free traveling seminars in the region.

The ImPACT test, employed by Dr. Solomon and his colleagues, is thorough but expensive. SCAT 3 is a free, on-line alternative assessment tool for teams or schools with limited resources. It is designed for use by medical professionals. (www.bjsm.bmj.com.content/47/5/259.full.pdf).

On Jan. 1, 2014, Tennessee will implement a far-reaching law regarding concussions. The regulation will apply to school and community-sponsored sports for participants 18 years and younger. Annual training is mandated for coaches and trainers. Parents and athletes will be given fact sheets regarding prevention and recognition of concussion. Every athlete diagnosed with a concussion after that date must undergo evaluation and clearance from a physician or neurophysiologist with clinical training before he or she can return to practice and participation in their sport. Injuries to cheerleaders must not be overlooked.

Contact Clif Cleaveland at cleaveland1000@comcast.net.

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