Third of three parts
By Christine Kilgore
Special to the Falls Church Times
Sept. 4, 2014
Concussion diagnosis and management at George Mason High School continues to advance, with the Athletic Department set to begin its second school year with a new neurocognitive testing system that it believes is more reliable and comprehensive than the formerly used ImPACT system.
The department also will continue its foray into research aimed at improving concussion diagnosis and the tracking of recovery.
A concussion diagnosis is based primarily on symptoms, but neurocognitive testing is widely regarded as a useful tool to aid in the diagnosis and management of concussions in youth. The computerized tests assess areas of brain function such as memory, thinking speed, and reaction time, all of which can be impaired by concussions.
In high school athletics, the tests are most often used to assess possibly-concussed athletes against a baseline established prior to the sports season. Testing can then be repeated periodically post-injury to help guide recovery. (While not ideal, the test can also be performed in the absence of baseline results, with findings sometimes useful.)
In addition to being offered through a growing number of high school athletic programs, neurocognitive testing is done at some sports medicine clinics and hospitals, such as the SCORE program at Children’s National Medical Center in Washington; it is not a part of routine primary care practice.
In the 2013-14 school year, Vicki Galliher, George Mason’s athletic training coordinator, put aside the ImPACT test, which she had used for nine years and which became the gold standard in high schools and colleges, in favor of another neurocognitive test battery called Concussion Vital Signs (CVS). She had pilot-tested CVS in the spring of 2013 with George Mason’s cheerleading squad.
The CVS test assesses additional domains such as executive function and the ability to shift attention. It also provides a more detailed look at reaction time and includes a “clinician portal” by which–with parental permission–a physician or other health care provider can see Ms. Galliher’s test results and notes, and vice versa. This portal was a “big sell” for her and has been viewed favorably overall by involved families so far, Ms. Galliher said.
Athletic director Tom Horn said the test has embedded validity indicators and appears to be providing more reliable results, giving Ms. Galliher and the department more confidence in interpreting and utilizing test scores. “If it appears there is a poor effort or an abnormality for some reason, for example, we’ll get an invalid result rather than just a lower score,” he explained.
Indeed, neurocognitive testing is only one piece of the diagnostic pie, and it’s not perfect. Many factors–from test setting to fatigue to various psychological factors–are believed to influence test performance, and researchers are working to improve the tests’ ability to accurately measure concussion-induced changes in brain function.
George Mason High School became involved this year in some of this research through a partnership formalized in the summer of 2013 with Pearson Education, which developed the CVS test, and Anthrotronix, an engineering and research development firm based in Silver Spring, that works with the U.S. Department of Defense on its concussion assessment protocols. (The military’s main tool, DANA, is similar to Pearson’s CVS).
Anthrotronix approached George Mason after learning of Ms. Galliher and was “instantly impressed with the breadth of her knowledge and expertise as a leader in the field,” said a company spokesperson.
Results of a first pilot study involving sideline and classroom assessments of George Mason’s football players last fall included the finding that testing conditions did not impact median reaction times. Another pilot study being planned for the upcoming school year will look at how cognitive functioning varies during the course of the school day. As with the first pilot study, data will be made anonymous and informed consent will be obtained.
“Already,” said Ms. Galliher, “the information we’ve given [Anthrotronix and Pearson] has led to refinements in the neurocognitive test protocols that are being used to test our own students.”
Said Mr. Horn, “To have our staff and kids participate in a research project that will benefit both military personnel and future athletes–it seems like the right thing to do.”
Second of three parts
By Christine Kilgore
Special to the Falls Church Times
Sept. 3, 2014
Virginia’s recent expansion of its student-athlete concussion law calls upon high schools to ramp up the attention given to the cognitive aspects of concussions. But George Mason High School is ahead of the curve.
Legislation passed in the 2014 Virginia Assembly not only requires recreational sports teams that use school property to have concussion policies in place; it also addresses the issue of academic accommodations for high school athletes who have suffered concussions.
Where the state’s original concussion law from 2010 focused on removal-from-play and return-to-play issues in interscholastic sports, it did not elaborate on the cognitive side of head injury. The new legislation expands this law, mandating that school personnel, student athletes, coaches, and parents be informed of the effects of concussions on student-athletes’ academic performance. A second, related bill passed in the 2014 General Assembly requires the state Board of Education to include a “return-to-learn protocol” in its guidelines for school division concussion policies.
These new mandates are gratifying to Vicki Galliher, Mason’s athletic training coordinator, who for several years now has led training sessions for teachers and staff on concussion recovery and the importance of cognitive rest and academic accommodations.
A return-to-learn (RTL) protocol that she developed has garnered attention outside the City for its thoroughness. Last year, she described the FCCPS protocol in a professional webinar that was tapped by educators and athletic trainers across the country.
“You can’t push through a concussion,” Galliher said in a PTSA-sponsored presentation last fall. “I always tell our parents and kids, it’s better to take a week, two weeks, or two months [significantly limiting cognitive activity] than to try to push through each day and end up missing an entire school year or, 25 years from now, not being able to remember what high school you went to.”
Cognitive recovery–regaining the ability to function cognitively without exacerbation of headache or other symptoms–has in recent years come to be viewed as a prerequisite for return-to-play or the resumption of any significant physical activity after a concussion. No two concussions are the same, experts now say, so the pace and course of recovery can vary significantly among individuals.
A return-to-learn (RTL) process, whereby students are gradually integrated back into school and the rigors of classroom participation and study, provides a framework to support this recovery. Last year, the American Academy of Pediatrics issued a report on “returning to learn”–the first such report in the medical community.
Under the FCCPS RTL protocol, which the athletic department says will be formally incorporated into the school system’s student-athlete concussion policy, Ms. Galliher works with students and their families and physicians on tracking symptoms and guiding their cognitive recovery. Periodic neurocognitive testing is utilized as needed.
Ms. Galliher advises teachers and staff on the needs and limitations of each injured student–how often breaks are needed, and how much the student should participate and study, for instance. Often, this process of defining limits on cognitive exertion and monitoring academic accommodations requires daily review and communication. A student may be instructed to have maximal 10-minute study periods, for instance, or be a more passive learner for a while, listening to discussions but not taking notes until symptoms are diminished.
The challenge for the City’s school system when it comes to RTL–as with other school systems throughout the Washington region–is that RTL processes are tied to the high school’s athletic program. Exactly how a student who sustains a concussive injury outside of high school sports will be supported has been unclear and/or variable.
High school athletic trainers have the most knowledge and are best positioned to serve as academic liaisons–doing what Ms. Galliher does–when concussions occur. But do athletic trainers have the time to help all students who need them?
Asked recently about concussions in non-high school athletes, the athletic training administrator for Fairfax County Schools, John Reynolds, just laughs. “We’re working through these issues right now.”
“On one hand, it’s a good thing (to be able to help non-student-athletes with concussion recovery),” he said. ” On the other, it creates an additional challenge…How much of the process can we take on?”
Overall, the size of the City’s school system may be helpful in this regard. Ms. Galliher publicly said for the first time last fall that she is the “go-to” person for academically supporting all FCCPS concussed students, regardless of their age or place of injury.
In the 2013-14 school year, Ms. Galliher was given more time to devote to this role, though undoubtedly there is a limit to how many student concussion cases she could thoroughly oversee at any one time. (During the 2013-14 school year, she handled 40 medically confirmed concussions, each of which necessitated an individualized RTL protocol.)
Athletic director Tom Horn said that with a physician’s diagnosis and orders to do so, Ms. Galliher can perform neurocognitive testing and can help guide a concussed student in any of the FCCPS schools through a period of academic accommodations. “If a physician says there is a need to intervene academically, then by all means she is here,” Mr. Horn said.
Tomorrow: George Mason High School Takes on Concussion Research
First of three parts
By Christine Kilgore
Special to the Falls Church Times
Sept. 2, 2014
A little-noticed amendment to Virginia’s student-athlete concussion law aims to go beyond high school athletics and also protect recreational athletes. And Falls Church City officials are evaluating how best to respond.
The law–revised this spring in the Virginia legislature –now requires recreational sports teams that use public school property to develop policies for “identifying and handling” suspected concussions.
The new rules took many by surprise, including Daniel Schlitt, director of the City’s Recreation and Parks Department. He learned of the new requirement toward the end of the 2013-14 school year from George Mason High School Athletic Director Tom Horn, who offered assistance to the department as it works to implement the rules.
“This is the first time we’ll be dealing with a [major] health and safety issue,” Schlitt said.
The department administers programs in flag football, basketball, and soccer that utilize Falls Church City Public Schools space. Once a policy is adopted for these teams, Schlitt said, it likely would be utilized across-the-board for all youth sports teams administered by the department.
It is unlikely that a concussion policy will be in place for the fall sports season, he told the Falls Church Times, adding that a legal review by the City’s attorney would be the first step.
State Senator Richard Stuart and Delegate Richard Anderson, who sponsored the House version of the new law, both said they were driven by the urgings of Michelle and Gil Trenum of Nokesville, whose 17-year-old son Austin took his life in 2010, two days after suffering his second concussion during a football game.
“The Trenums always pointed out that while Virginia had passed legislation to protect youth in high school sports, this didn’t extend to other teams and other youth,” Anderson said.
For Sen. Stuart, a concussion his son suffered at the age of 15 also was eye-opening. “He had to stay in a dark room with no stimulation…I had no idea that it [a concussion and its treatment] was so serious,” he said, adding that he also more fully understands now that multiple concussions or sub-concussive injuries can have a cumulative impact on the brain.
Virginia’s initial concussion law, passed in 2010, requires high school student-athletes to be removed from play when a concussion is suspected, and not to return until cleared by a health care provider (a definition that, in this law, includes athletic trainers). The law also mandated that school divisions develop their own policies and procedures, and that they annually educate students, parents, coaches, and other school staff about concussions.
FCCPS had been ahead of the curve with its attention to head injury and its use of neurocognitive testing to aid in diagnosis prior to the state mandate, but it subsequently developed and adopted a policy, “Student-Athlete Concussions During Extracurricular Activities,” in 2011.
The state’s new amendment stipulates that “non-interscholastic youth sports programs utilizing school property” should either adopt and follow the policy of the local school division, or develop their own policy, as long as it’s consistent with the local school division’s policy or the Virginia Board of Education’s guidelines for policies.
Sponsors of the state’s amendment say it is not meant to be cumbersome, but rather to further sensitize coaches and to promote more awareness. “Nobody expects [experts] to be engaged at the sidelines,” said Sen. Stuart. “But certainly, there are signs of concussion that can be observed [and acted upon].”
Athletes who have sustained concussions may appear dazed or move clumsily, answer questions slowly, or be unsure of a score, an opponent, or an instruction. Symptoms athletes can feel include headache, blurry vision, or simply “not feeling right.”
Unfortunately, such signs and symptoms may not be apparent for hours–or longer–after injury. Various sideline assessment tools are available and are utilized at George Mason and other Washington-area high schools, but appropriate training is required and false negatives are still a problem.
In this sense, the new requirement takes Falls Church City and other communities in the state into important but uncharted territory. Among the questions that may arise as City officials craft a policy are: What tools and assessment processes can best be learned and utilized by volunteer coaches? How much training is required? To what extent should coaches follow up after concussions are suspected? To what extent can and should parks and recreation departments work with local school systems?
George Mason’s Tom Horn said Falls Church City’s small size may be advantageous.
“In an ideal world, in a community like ours, we’d have an extensive partnership, where the school facilities and technology would help [the recreation department] implement its own policy….and where we’d follow the same educational requirements [for returning to the classroom, instance],” he said. ” But if they’d ever want to do baseline [neurocognitive] testing of all youth participants, then we’d have a huge resource issue.”
In terms of enforcement, the law says local school divisions “should not be required to enforce compliance” with the new policies. Sen. Stuart and Del. Anderson both said, however, that it would be up to school divisions to ensure that recreational programs using their fields have policies in place.
A similar version of the amendment was introduced in the 2013 legislative session but failed in the House Education subcommittee over concerns about possible legal liability of coaches. In 2014, legislators “took out provisions that could have exposed volunteer coaches to legal liability,” Rep. Anderson said.
Tomorrow: In FCCPS, Return-to-Learn Protocols Are Well-Seasoned
By CHRISTINE KILGORE
February 19, 2012
Youth concussions leave parents and educators with “one opportunity,” Vicki Galliher often says, to manage recovery properly. If not done correctly, recovery from concussions can be prolonged, and the potential for long-term neurological risks may be magnified.
Ms. Galliher, the Athletic Training Coordinator at George Mason High School, is the driving force behind a critical trend in Falls Church City Public Schools: A long-standing but growing appreciation by school officials, educators, and parents for the role that cognitive rest–and individualized, fluid plans for academic accommodations–play in proper concussion recovery.
It’s not only the physical rest and return-to-play decisions that are important. Cognitive rest is critical as well–and this often means time out of school, modified academic schedules, and other changes at home and at school.
“I think we’re now more cognizant of how complicated concussions truly are,” says Dr. Seidah Ashshaheed, principal at Mary Ellen Henderson Middle School. “It is imperative that we do our part as a school by being informed and supportive [with cases of concussion].”
High School Concussions – A Frequent Occurrence
When I began researching the issue of concussions among youth in our community, I learned how frequently concussions occur among FCCPS students.
Examples abound: The high school football player who felt incredibly tired and slept long stretches, and was later determined to have a concussion. The lacrosse player who suffered his second concussion, prompting his parents to steer him to non-contact sports for six months. The hockey player who just felt “out of it” after a game in which he’d taken a hard hit. The middle school soccer player who struggled with headaches and fatigue for weeks after a collision and concussion.
I also saw first-hand, in researching the science of concussions and concussion recovery, how much of the current knowledge of concussions has been acquired just in the last 10 years–and how fast it is evolving. There are many uncertainties, but research has clearly shown that children and adolescents are more susceptible than adults to concussion in the first place, that they are slower to recover, and that they are at higher risk for “second-impact syndrome.”
Studies have shown that once an individual suffers a concussion, he or she is four times more likely to sustain a second one. In addition, a growing body of research is showing that the cumulative effect of multiple concussions increases the risk of neurodegenerative health problems later in life.
I also learned, in trying to unravel my daughter’s health issues and hearing others’ stories, that concussions are under-identified and often arbitrarily treated in the medical community at large, despite an extensive “Heads Up” educational campaign launched by the Centers for Disease Control and Prevention in 2005.
Many physicians don’t appreciate that concussions can result from impacts to the body that jar the head, or from rapid accelerations brought to a sudden stop. Collisions or direct blows to the head are often involved, but aren’t a requirement. Concussions can manifest in many different ways, and symptoms may not occur for days after the injury.
Even when a concussion is suspected, the message from physicians who have not been trained in these brain injuries may be vague–to “take it easy” for a week, for instance.
In reality, recovery should be much more deliberate and measured. The pathophysiology of concussion isn’t completely understood, but most experts agree that concussions cause neurometabolic impairment and significant changes in the balance of neuro-chemicals in the brain. Such changes can effect one’s ability to think and learn, to stay awake and alert, to function well socially and emotionally, and to tolerate noise, light, and motion, among other things.
“The [concussed] brain is in an energy crisis, a metabolic crisis, so treatment must involve conserving the brain’s energy,” says Dr. Joel Brenner, a pediatrician at the Children’s Hospital of the King’s Daughters in Norfolk.
“We treat concussions completely differently than we did 5 years ago,” said Dr. Brenner, who chairs the American Academy of Pediatrics’ Council on Sports Medicine and Fitness and has been working to educate physicians and others about concussion. “We don’t grade concussions anymore, for instance, and we don’t send someone back after a week as a blanket statement . . . There has to be an individualized treatment plan.”
But before treatment can begin, one must identify the concussion, which can be difficult using traditional observation techniques. Even an MRI or other standard imaging technique typically cannot measure the changes in the brain following a concussion.
To provide a better method of identifying a concussion, the medical profession is increasingly turning to “neurocognitive testing,” in which persons suspected of having concussions take tests to measure their cognitive abilities. Ideally, athletes will have been tested before the season begins in order to establish their “baseline” performance, which can be compared against later performance to detect changes in the brain.
Neurocognitive testing, sometimes called neuropsychological testing, has been recommended in several major consensus statements and is widely regarded as the cornerstone of concussion assessment and recovery. According to a recently published survey of high schools that participate in a national injury surveillance system, about 40% used neurocognitive testing in the 2009-10 school year, up from 26% in 2008-09.
ImPACT – The “Gold Standard” of Neurocognitive Testing
George Mason High School’s concussion recovery protocol is based on use of the ImPACT test– a computerized neurocognitive exam with seven modules that measure aspects of cognitive functioning including memory, concentration, reaction time, and processing speed.
ImPACT, which stands for “Immediate Post Concussion Assessment and Cognitive Testing,” is not the only such system available, but it has fast become the gold standard. It was developed at the University of Pittsburgh Medical Center by psychologists Mark Lovell and Micky Collins and neurologist Joseph Maroon, the Pittsburgh Steelers team neurosurgeon. ImPACT is utilized throughout professional sports and among many colleges and high schools. (While many high schools do not employ neurocognitive testing, let alone have an athletic trainer, the vast majority of those schools that do use neurocognitive testing have chosen ImPACT.)
At GMHS, Galliher uses ImPACT to test possibly-concussed athletes against a baseline established prior to the season. The test takes approximately 20 minutes, with students sitting at a computer reacting to different on-screen tasks. Comparing the before-and-after test results allows Galliher to document the presence or absence of injury and even quantify specific areas of dysfunction. Used in conjunction with symptom reporting and clinical assessment, repeated ImPACT tests also can help guide recovery. (The test can be performed in the absence of baseline results, but its true value cannot be realized since each individual is different).
The George Mason athletic department advises all GM athletes participating in moderate-to-high-risk sports to complete baseline ImPACT pre-season testing. This year, boys tennis has also elected to participate (one of their players sustained a concussion last year during match play). Parents have the option of opting their child out of the baseline testing program, but Coach Galliher says she’s never had a parent refuse.
When Coach Galliher implemented the ImPACT protocol in 2003, George Mason was one of approximately 250 high schools nationwide that were integrating the protocol into their athletic programs. She had sought out the best of training, working at the University of Pittsburgh Medical Center’s Sports Concussion Program with the neuropsychologists who founded the software and testing protocol, as part of her overall ImPACT education and certification.
“The initial reaction [to the ImPACT program] was really positive because we were providing care not available elsewhere,” said Tom Horn, athletic director at George Mason. “And we were removing ambiguities in terms of whose call it is to return a student-athlete to play.”
Many GMHS parents have become believers. “My son’s doctor completely missed the concussion,” said one father. “My son collided with another player in a game last spring and didn’t feel himself afterward. There was no loss of consciousness, no headache, no memory loss, so the doctor felt there was no concussion. But when Coach Galliher readministered the ImPACT test, his performance was so diminished, there was no question he had a concussion. And then we started to see more symptoms a couple days later.”
“Thank goodness she caught it,” the father said. “If we had let him return to play at that time, it could have been very dangerous.”
For Ms. Galliher, the testing protocol also has worked hand-in-hand with symptom monitoring–and with physicians’ instructions, in some cases–in guiding academic planning, managing cognitive exertion, and determining when students can resume a full schedule of school attendance and studying. (In concussion treatment, complete cognitive recovery–the ability to function cognitively without any exacerbation of symptoms–is a prerequisite for reintroducing physical activity. It can take days, weeks, months, or longer for cognitive recovery. Prompt diagnosis and proper management lessen the risk of prolonged recovery. )
Ms. Galliher works with students and families on guiding the recovery process, meeting with students and parents and communicating with teachers and staff about each student’s limitations and progress. Last month at one point, she was working on 14 concussion cases at George Mason and Mary Ellen Henderson Middle School (“MEH”).
For the GM student who sustained a concussion in a hockey game last year, recovery meant several days at home followed by a flexible school schedule (going in late and leaving early) and a study regimen with maximal 10-minute study periods and no computer time (the subconscious mind picks up on the refresh rates of screens). Gradually school and study time increased until symptoms were gone and ImPACT results were back to baseline.
Others have been instructed to be more passive students for awhile, listening to discussions, for instance, but not taking notes or completing worksheets or homework. Some are instructed to retreat to quiet places for breaks, or vary their transit times in order to traverse the halls with fewer students. Many require significant limitations on smart-phone use and texting.
“There’s no standard protocol [in the medical world] for reintroducing cognitive learning as there is for reintroducing physical activity. For me, the whole process [of facilitating cognitive recovery for our students] has evolved…we’ve needed to develop and hone it,” Ms. Galliher said. But with processes in place, “you can feel a palpable sense of relief from teachers and parents,” she said. “Before, you could see how stressed kids were about getting behind on schoolwork, how confused teachers were about giving homework, or not giving homework…no one knew what to do.”
Says one parent of an MEH student who recently sustained a concussion, complaining only of a headache several days later: “Coach Galliher taught us that the symptoms do not necessarily present as we thought. And it was very important for us to learn that cognitive rest was important to his recovery.” Says another parent of a GM student: “She is relentless and lays down the law” for proper recovery.
Ahead of the Curve
It is a sign of urgency–a sign of the rapidly increasing attention being paid to concussions in adolescent and teen athletes–that 35 states now have laws addressing student-athlete concussions. (In 7 other states, bills are pending.) Several bills addressing concussion safety and management for student-athletes were introduced in Congress in the past two years, but the states have raced ahead, following the lead of Washington State, which in 2009 passed the Zackery Lystedt Law, named after a teenager who suffered a major brain injury after returning to the football field too early.
Virginia’s law requires student-athletes to leave competition or practice when a concussion is suspected, and bars return-to-play on the same day–and until athletes are evaluated and cleared by “an appropriate licensed health care provider” (a definition that includes licensed athletic trainers). The law also requires school divisions to develop policies and procedures for identifying and handling suspected concussions (including addressing academic needs and cognitive demands). Schools must also annually educate coaches and other school staff that advise student-athletes, as well as the students themselves and their parents or guardians.
The Falls Church City Public Schools approved a policy on “Student-Athlete Concussions During Extracurricular Activities” in June 2011 that establishes a “concussion management team” and addresses issues of concussion education and return-to-play decisions. The policy is based on one of the models developed by the Virginia School Boards Association in the wake of the new state law.
To a large extent, however, the new state law and FCCPS policy codify the approach that Coach Galliher and the George Mason athletic department have taken for years. “Coach Galliher brought this to us much earlier,” said Craig Cheney, president of the GMHS Athletic Boosters Association and a former FCCPS school board president. “She’s brought a whole new level of knowledge to us as parents and to teachers. And fortunately, the advantage of a smaller school system is that we can disseminate knowledge much more easily and quickly.”
Ms. Galliher says most importantly, the law puts teeth into efforts to educate student-athletes and their parents. This year, for the first time, completion of an online certificate course about concussions is an annual requirement for each student’s participation in a school’s athletics programming.
“It’s a common perception that football is the main culprit, but for every concussion I’ve seen in GM football, I’ve seen another one in soccer, cheerleading, volleyball, and other activities,” Galliher noted.
Also for the first time, Ms. Galliher provided the same concussion education programming this past fall for MEH faculty and staff, at Principal Ashshaheed’s request, that she has regularly provided for GM staff. Matt Sowers, an MEH school counselor and head coach of the boys varsity tennis team at GM, said the session was informative and impressed upon him how “imperative” it is for educators to understand how concussions can affect students, and to stay on top of the latest knowledge on brain rest and treatment.
“We were amazed at how long [it can take for] full recovery,” he told the Falls Church Times.
Some of our state lawmakers, in the meantime, are discussing the possibility of introducing additional legislation to protect youth who participate in recreational athletic programs, according to Dr. Brenner, who worked with state officials on implementing Virginia’s concussion law.
“One of the biggest research questions right now is, what are long-term outcomes of these young athletes who have concussions–whether it’s one, two, three, or more?” said Dr. Brenner. “Will the 14-year-old who’s had two concussions, for instance, have any memory or attention problems when they’re 30 or 40? We don’t know this quite yet.”
My own review of the medical literature has shown me that research is indeed quickly moving beyond case reports of professional athletes (autopsy-based reports of chronic traumatic encephalopathy in former NFL players, for instance) to more systematic research on brain changes in athletes–both those who’ve sustained symptomatic concussions, and those who incur repeated thumps to the head or other stresses to the brain.
Ms. Galliher is closely watching such research. “As recently as 3-4 years ago, the school of thought was that if you allowed for sufficient recovery, you wouldn’t be at any greater risk for a subsequent concussion,” she said. “But now, regardless of recovery time, we’re starting to see a potential impact of consecutive concussions–on seizure-like activity, for instance, and on [Alzheimer’s-like neurodegenerative] changes.”
It is conceivable, said she and Mr. Horn, that in the future, science may identify particular thresholds that will lead to changes in practice parameters–like limits in the number of headers a soccer player should incur during practices. For now, the goals of promoting safe play, ensuring early detection, and facilitating complete recovery are key for FCCPS.
“You can’t cast your brain like you can a broken leg, but you can minimize stimulation and let it rest….You have one opportunity to manage it correctly,” Ms. Galliher said.
NOTE: Coach Galliher will lead a presentation and discussion of concussions and their impact on February 22nd at 7 p.m. in the GMHS Cafeteria. The program, “The Anatomy of an Adolescent Concussion: It’s Not Child’s Play,” is co-sponsored by the FCCPS Student Health Advisory Board and the George Mason Athletic Boosters.
By CHRISTINE KILGORE
Falls Church Times Staff
May 25, 2010
Fairfax County Health Department officials have been working over the past several weeks to prevent the spread of pertussis in Mary Ellen Henderson Middle School, urging parents to keep children with symptoms at home until seen by a doctor and encouraging preventive medication in some children deemed to have had close contact with an infected student.
Pertussis, or whooping cough, is a bacterial, communicable illness that can be especially serious for infants and young children who have not yet completed the primary series of DTaP vaccine that protects against infection.
It is a reportable illness (physician and hospitals are required to report diagnosed cases) that, at least in Fairfax County, uniformly generates a public health response. And paradoxically, it’s a vaccine-preventable illness whose rates have been rising since the 1980s rather than falling.
And then there’s the fact that pinpointing suspect cases among children who are coughing from allergies, asthma, colds, and other infections is no easy feat.
As my 11-year-old daughter said recently, “everyone is coughing!”
Her class—the 5th-grade—has borne the brunt of this episode. The medical community has learned over the years that the immunity created through vaccination wanes over time—and for the past 4 years, students have been required by state law to have a booster dose of pertussis vaccine to enter 6th grade.
For at least some families, getting the booster is still on the ‘to-do’ list—and consequently, the 5th grade overall is the most susceptible to waning immunity and the spread of infection.
“We used to see kids in the 6th and 7th grade getting pertussis, but now we’re seeing less of that,” said Fairfax County Health Department’s Dr. Peter Troell in an interview last week. “Now we see cases still among the 5th graders, and among some of the older high school kids who didn’t have to meet a [6th-grade booster] requirement.”
It’s “not uncommon” for the health department to investigate cases of pertussis in schools, said Dr. Troell, medical epidemiologist for the health department. “Generally, when we see pertussis, we see 1, 2 or 3 cases [in any school].”
Pertussis in adolescents and other individuals who were vaccinated earlier in life often is mild, and according to Dr. Amin Barakat of Northern Virginia Pediatric Associates, may even go “unrecognized” in mild cases.
Often, Dr. Troell explained, “those who are vaccinated have only a little bit of feeling bad before the cough onset, maybe a bit of a runny nose, and then go into a cough that’s milder than what’s described for the classic case of pertussis.”
It can be difficult sometimes to distinguish pertussis from, say, allergies that aren’t well treated, but generally the cough associated with pertussis is more persistent, he said.
Classic pertussis is characterized by a period of cold-like symptoms that progresses to bursts or spasms of severe coughing and characteristic whooping that can be severe enough to induce vomiting. Before killed whole-cell pertussis vaccine was introduced in the 1940s, whooping cough was a major cause of infant death worldwide. (The safety of whole-cell pertussis vaccines prompted development of the acellular vaccines used today.)
Today, there are still reports of major complications—from hypoxia and pneumonia to encephalopathy and death–among children who are unvaccinated or too young to be vaccinated. Vaccination and preventing spread through communities are thus key public health goals.
MEH Principal Dr. Ann McCarty informed MEH parents in mid-April about a case of pertussis and asked that children with persistent cough see their physician and, if pertussis is confirmed or suspected, stay home until 5 days of an antibiotic regimen is completed. This month, parents of children who were deemed through “contact tracing” to have had close contact with an infected student were asked by the FCHD to “see a physician for preventive medication.”
(In this case, prophylaxis is identical to the treatment—the same antibiotic regimens. Though not without any controversy, judicious use of antibiotic prophylaxis for household and close contacts is a common public health recommendation.)
The most accurate test for pertussis involves a nasophayngeal swab, Dr. Barakat says. Results can be ready in 48-72 hours.
The increase in pertussis since 1980 has disproportionately affected adolescents and adults, and for several years now the Centers for Disease Control and Prevention has recommended “catch-up” use of a pertussis-containing booster vaccine in adolescents who did not receive a booster at 11-12 years old. Adults younger than 65 who haven’t had pertussis-containing vaccine as an adult can also substitute one of their tetanus-diphtheria boosters with a Tdap vaccine.
Such advice holds weight for me: A friend of mine had pertussis last summer and it wasn’t easy. Before being diagnosed and treated, she had a difficult time with posttussive vomiting. According to an infectious disease report I recently read, numerous studies have suggested that pertussis comprises 20-30% of all cases of persistent cough among adults lasting two weeks or longer.
Interestingly, though, pertussis is no longer contagious after a person has been coughing for more than 21 days, Dr. Troell said.
And certainly, there are many questions still challenging physicians and researchers—about pertussis pathogenesis and immunity in adolescents and adults, for instance, as well as how to best prevent and control outbreaks.
This past soccer season was a season unlike any other for a group of Falls Church-area girls—one in which teamwork took on almost unimaginable meaning.
The girls of Premier AC’s 97 Fusion, a U-12 travel soccer team, not only played soccer — they spent hours each week after soccer practices learning the “Diski” dance — a special dance created for the FIFA 2010 World Cup to be held this summer in South Africa. The dance captures both the culture of South Africa and the moves and rhythm of the game.
Their filmed interpretation of the “Diski” won them 1st place in a Diski Dancing video competition sponsored by South African Tourism –and an 8-day tour of the World Cup’s host nation. The 14 girls will take their trip in late March.
“At the beginning I thought, ‘we won’t win,’ said 11-year-old Rebecca Davis of Falls Church City. The dance moves also “seemed a bit odd at first,” she said. “But as we practiced we got to the point we could even do it without the music.”
When she learned through a text message that her team had won, she screamed. “I then called a teammate,” Davis recalled, “and my teammate was so happy she started crying.”
Stacey King, the team’s coach, learned of the competition in mid-October while perusing the U.S. Youth Soccer Association web site. The contest criteria (to submit about one minute of video, for instance, and to use a specific soundtrack) were simple, and the challenge of working creatively with the dance’s five main moves was enticing.
King’s mind raced. She envisioned ways of tying together the dance moves to simulate the flow of an international soccer game. She solicited initial reaction from the girls and their families by email, and then called the team to the Falls Church Community Center to present her ideas in detail.
Together, she and the girls and their parents watched a brief South African video demonstration of the Diski’s five main dance moves, and discussed the hours of teamwork and energy that would be required if they were to stand a chance of winning the competition.
The girls and their families promised their commitment and gave King input about moves and scenes to include and not include in the video.
From then on, through early December, the team practiced for two hours every week, immediately after their team training sessions. They also practiced for several hours between the games of a fall tournament, in a nearby gym that a parent had arranged to use.
And when it came time to film, they met four times in various locations, including during the snowfall on December 5 and in Washington, D.C., in front of the Lincoln Memorial and in the shadows of the Washington Monument.
“Everybody made it work,” said King. “The parents helped with arranging locations to practice, with filming and editing and other ideas, and with grabbing coats and supplies, and the girls never complained — they were always excited.
“It was a complete and total team effort,” she said.
Evelyn Loeb, Rebecca’s mother and the parent manager of the team, said the girls were so committed to the project that when King came down with the flu before one of the last scheduled soccer/Diski dance practices, “the girls carried it through on their own, directing and going through everything themselves.”
The team’s goal, said King, was for the progression of scenes in the video to represent “the flow and feel” of an international soccer game.
“And I wanted to make sure we represented the feel and culture of South Africa as best we could,” she said.
Viewers hear the South African national anthem at the beginning and see a team photo mimicking the typical “starting 11” photo taken at major games as well as a kick-off. One scene simulates the often underappreciated role of the goalkeeper, King notes, and almost everything in the dance is done as if each girl has or is about to make contact with a ball.
The video includes a photo of a red “vuvuzela,” a stadium horn commonly blown by fans at South African matches, and shots of the girls sporting the colors of the South African national team (as well as the pattern of the South African flag on their faces). Read more