We finally understand that the brain is an important organ to protect, especially in young athletes.  For those of you who have been around long enough to watch any of the Mohammed Ali boxing matches with Joe Frazier or George Foreman, it may have come as no surprise when Ali developed post-concussive brain complications.  At that time, concussions were considered a minor inconvenience.  Since then, we have learned a great deal about traumatic brain injury.  Professional championship boxing matches were routinely 15 rounds, but now are limited to 12 rounds.  Even in the Mixed Martial Arts (UFC) competitions that are so popular now, referees seem to be fairly quick to end matches when a competitor appears to be facing a severe concussion. We have learned about the risk of life-threatening cerebral edema when a second concussion follows the initial injury without time for the brain to recover. We have also learned about post-concussive syndrome, which can result in poor cognitive function as well as depression and mood problems for longer periods of time after concussion.  In addition, there is evidence of late risks of Parkinson's disease and dementia, as a result of concussion(s).

In the state of Washington, this has become even more of an issue because of a bill now signed into law that mandates school age athletes receive specific care prior to returning to sports participation.  The Washington Interscholastic Athletic Association (WIAA) has a web site that gives excellent guidelines to coaches, parents, athletes, schools and health care providers on the expected management.

The highlights of the guidelines and regulations are stated:

On a yearly basis, a concussion and head injury information sheet shall be signed and returned by the youth athlete and the athlete's parent and/or guardian prior to the youth athlete's initiating practice or competition.

A youth athlete who is suspected of sustaining a concussion or head injury in a practice or game shall be removed from competition at that time.

A youth athlete who has been removed from play may not return to play until the athlete is evaluated by a licensed health care provider trained in the evaluation and management of concussion and receives written clearance to return to play from that health care provider."

Fortunately we now have consensus tools for coaches and trainers to use in the evaluation of athletes.  The 3rd International Conference on Concussion in Sport in 2008 endorsed the Sport Concussion Assessment Tool 2 (SCAT2).  The SCAT2 gives clear guidance for management of athletes with concussion.

Most importantly, we as a medical community and the coaches and trainers caring for athletes at practices and competitions now are aware of the need to treat concussions as a serious problem, and we have protocols in place to appropriately manage these athletes.