Experts piece together new treatment protocols for student athletes

Bill Villa was concerned. He’d learned his grandson was riding a stationary exercise bike just a few days after a concussion.

“That surprised me,” the Chaminade athletic director said. “Because that wasn’t our protocol. You had to be symptom-free for a longer time.”

Jessiya Villa, Kahuku’s star point guard who led his team to a 2017 state basketball championship just a couple of weeks later, was not rushed back to activity adding risk of another concussion. He was monitored closely by certified athletic trainers and physicians for possible aggravation of his symptoms, and as the symptoms dissipated it was determined he could gradually return to normal school and sports routines.

The goal is to get concussion sufferers moving and back to normal health and fitness quicker than what used to be common practice. A side benefit is young student-athletes may be more likely to report concussion symptoms if they know they won’t automatically be shut down from participating in sports.

It’s almost a complete turnaround from fairly recent prevailing protocol for concussion treatment that included plenty of bed rest, no exercise and very little human interaction or stimuli of any other kind — sometimes for nearly a month after a concussion. No texting, no gaming, no TV, no phone … concussion sufferers were literally left in the dark.

Concussions are nothing new. But with their huge impact on football and the NFL in particular in recent years, focus on the topic is at an all-time high. Medical research indicates concussions can cause chronic traumatic encephalopathy (CTE). CTE has been linked to symptoms including memory loss, headaches and depression, and in some cases death.

The NFL continues to grapple with the issue. The league voted for a rule last week making it a penalty if a player “lowers his head to initiate and make contact with his helmet against an opponent.” There is also speculation that kickoffs, in which there are a significantly higher rate of concussions than on other plays, may be eliminated from the game.

But concussions can occur in all contact sports, at all levels of play.

Locally, the Hawaii Concussion Awareness Management Program reports there were 911 concussions diagnosed in 67 Hawaii public and private high school athletic programs in 2015-16, down from the 947 in 2014-15.

When Maika Hanta suffered a concussion while playing softball as a sophomore at Maui High in 2014, she was held out of school for nearly a month and was prevented from working out at all. She said she felt the care she received was good, but that the extended period of complete rest may have negatively affected her ability in school. She also suffered from feelings of isolation and depression because she was away from peers.

People who have concussions sometimes suffer symptoms similar to those of vertigo, including dizziness and balance difficulties. A year after her concussion, Hanta fainted at a Fourth of July fireworks show. She said she still has some problems in crowds.

“Going to concerts is too much,” she said.

Concussion experts like Dr. Rachel Coel, the director of sports medicine at The Queen’s Medical Center, still emphasize caution and rest for the first 48-to-72 hours. But Coel is also among those who recommend that concussion sufferers resume activity much sooner (but still without physical contact).

She emphasizes an important caveat: As appropriate.

Coel still goes by the mantra of, “When in doubt, sit them out.” And for the first one to three days after a concussion, “shutting them down.”

But, “A lot of research shows a role for (noncontact) activity (sooner),” she said. “What happened was like wrapping them in bubble wrap, the cocoon theory. But it’s been found that kids who rested long on average took five days longer to get better, and, didn’t feel good in general. There have been more and more examples of this in research.”

Sometimes parents don’t know about the new research, Coel said. She reassures them by showing them the medical studies indicating that, when appropriate, a more active approach than what was standard before is more effective in treating concussions.

“It was the first time I heard about (the change in protocol),” Bill Villa said. “(Jessiya’s) physician and trainer got him back to doing light activity and put him on the bike.

“In discussion with my athletic trainer (at Chaminade, Rebecca Duran), I learned this has changed. To my knowledge the results are positive, it’s not making it worse, and it’s helping. So we’ve adjusted. The more the medical field and professionals get more information, we start to see more change for the better. Research and up-to-date information supports it. Of course they monitor it very carefully.”

Jessiya Villa, who is committed to play for the University of Hawaii after completion of a religious mission in Ghana, is now free of any concussion symptoms, Bill Villa said.

“The idea is once they feel better get them moving and exercising, at least lightly,” said Dr. John Leddy, a sports medicine specialist and concussion treatment researcher at Buffalo State University in New York. “The idea of keeping them down until all symptoms are completely gone no longer has credence. It can make their symptoms worse. People keeping up with research and current guidelines know the cocoon theory is no longer in vogue.”

State Sen. Josh Green is an emergency room physician on Hawaii island.

“The first 72 hours we still want to keep them resting to avoid additional head trauma and inflammation,” Green said. “We’re very careful there. But, yes, after that … in many cases (doctors) are getting them more active sooner than in the past.”

Green, (D, Naalehu-Kailua- Kona), is among many medical professionals who have seen concussion symptoms worsen because of prolonged inactivity and isolation, especially in the cases of adolescent student athletes.

“Isolation can cause all kinds of problems. Depression, social maladjustment, these can really hurt the ability of kids to have normal encounters. You combine a head injury with isolation and you really could be doing a young person some harm. It’s good to re-engage, as long as it’s safe as cleared by a doctor.”

As symptoms began to dissipate, Hanta recovered from depression and could interact normally with friends and family. But four years after the concussion she still has some memory problems, including remembering important family milestone events.

“I’m still finding out that I’m missing pieces of memory as I go along,” she said.

She said she must put in extra effort reviewing material repeatedly to maintain her 3.5 grade-point-average as a University of Hawaii psychology student. “I have to start studying for tests way ahead,” Hanta said.

But in addition to doing well in school, Hanta has made a successful return to playing sports. During her senior year of high school she played varsity soccer, and her intramural soccer team recently placed second in the championship tournament at UH. She also works part-time at the Warrior Recreation Center.

“Concussion treatment methods are updated,” said Kelly Wescott, the head athletic trainer at Hawaii Pacific University. “The research used to say when you get a concussion you have to really limit anything you do and be a hermit crab and hide out in your shell. Now, you do limit the noise and light and intensity, for at least a couple of days. But as soon as the doctor says it’s OK, they should start returning to work and returning to play. It helps them feel more normal because being isolated doesn’t help.”

Troy Furutani, manager of the Hawaii Concussion Awareness Management Program, said it is important to remember that the new protocol of getting moving sooner does not mean returning to the playing field immediately.

“Return to play is a gradual process,” he said. “The first phase might be riding a stationary bicycle, or walking or a slow jog. And if they’re OK without any symptoms, then maybe the next day they can do more, a little more aggressive type of running, sprints. Then the next day maybe some non-contact drills.”

Duran, the Chaminade athletic trainer, said she has seen the positive results first-hand.

“When we can get them on a bike or treadmill, they respond better as far as symptoms.”

Concussions Statistics by Honolulu Star-Advertiser on Scribd