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can lead to more serious injury." The constant impacts can lead to an athlete being admitted to the hospital, and even though they meet the criteria, many concussions go undiagnosed as doctors focus on their patient's symptoms instead of on the cause. In response, Hughes and the rest of her team began to con- duct a retroactive brain injury screening process in the hopes of properly diagnosing trauma patients who meet mild traumatic brain injury criteria. In 2009, research showed that less than 38 percent of all patients admitted to the medical center for head trauma were properly diagnosed. After implementing new pro- tocols, 95 percent of all head trauma patients are now being properly diagnosed, and more are receiving the proper recom- mendations when they are released. "When you have a concussion that goes undiagnosed, you have a lot of these secondary problems that occur because the people themselves do not know what is wrong with them," Hughes said. In order to better identify a concussion, medical teams like Hughes' have begun to administer baseline testing. These tests are taken by athletes who are at a high risk for brain trauma due to the sport they play, but have never had a concussion. Before the season began, Hughes measured the athletes' reaction times, memory capacity, problem solving and mental processing speed. If the athlete suffered a brain injury, he took the test again. This way, medical professionals can track the changes. Companies like Pro-PT have begun baseline testing as part of their ImPACT concussion screening process. Rocky Cisneros, DPT, a physical therapist with Pro-PT, says that during football and soccer seasons, they see one to two concussion cases per week. That is significant since those two sports take up six of the nine months that school is in session. Pro-PT has implemented the ImPACT program at 20 high schools around Tulare, Fresno, and Kings counties. Both the state of California and the California Interscholastic Federation (CIF), the governing body for high school sports, now have laws in place to protect athletes from concussions. If an athlete is suspected to have sustained a concussion, he or she is removed from athletic activity for the remainder of the day. They are not allowed to return until that athlete receives a writ- ten clearance to play from a licensed health care provider, all in accordance with state law. The CIF has similar protocols in place with one difference be- ing a mandatory, 20-minute training session on concussions for coaches. With new protocols in place, and companies like Pro-PT being proactive about preventing head traumatic brain injuries, why is there no significant decline? Annually 1.4 million people in the U.S. still suffer from a traumatic brain injury according to brain- andspinalcord.org. Hughes can breathe a sigh of relief knowing that these protocols are in place. However, Hughes noted that many are not following these protocols, stemming from focusing too much on the wrong outcome, and that is a direct result of not knowing what is truly going on in the brain. "It is really important that a child is transitioned back to the classroom first instead of back to the field of play," Hughes said. "There may be some districts who are very good and others not so much when following those parameters." In the case of Sam it came down to not knowing what the symptoms of a concussion were. He believed that a concussion only occurred when a person loses consciousness because of the trauma; however, that rarely happens. Only about 5 to 10 percent of all concussions result in the person losing conscious- ness. Nevertheless, there is an entire list of warning signs that are often overlooked by coaches, officials, parents, and educa- tors in charge. The most common is a headache, feeling dizzy or foggy. There can also be some residual signs such as amnesia, or behavior changes such as irritability. There can even be sleep disturbance in the form of insomnia. One who is suffering from these symptoms might not have the ability to focus while in the classroom or while doing everyday activities, but the symptoms are only on the surface. For other common sports injuries such as a broken arm, the treatment focuses on the cause of injury and not just the symp- toms. When it comes to a concussion, too many times the focus is on treating the headache and not enough time is spent to un- cover the root cause of such symptoms. "We have to figure out why they are having these symptoms," Hughes said. "This is really critical when talking about brain in- jury." If Sam had been coached on the warning signs of a concus- sions, or if the medical professional would have taken the time to properly examine him, the young man could have avoided months of rehab. Instead, he had to teach himself to walk again and had to be homeschooled due to his level of assistance. If the proper protocols had been followed and education more widely available, Sam might have returned to school without any lasting effects. "All of this should be black and white, and it is not," Hughes said. "We are in the stone age when it comes to brain injury awareness," Hughes said. "I think here in the central valley in particular we are 20 years behind were we should be." BREANNA HUGHES TEAM LEADER LANGUAGE PATHOLOGIST FOR ACUTE CARE SPEECH 20 | CENTRAL VALLEY MEDICAL | WINTER 2017-18 Mental HealtH

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