As thousands of young athletes across Loudoun County begin the fall sports season, Inova Loudoun Hospital has opened a program designed to address a growing concern among parents, sports officials and the medical community: the effects of concussions on long-term health.
The Head2Head Concussion Management Program, at the hospital’s Lansdowne campus, uses advanced medical technology and a team of specialized therapists and physicians to evaluate patients with a mild traumatic brain injury (MTBI), commonly known as a concussion, to determine whether therapy is needed and to provide care tailored to the patient’s needs.
Ron Waldrop, medical director of the clinic, said that when a concussion occurs, the brain has injured cells that cannot be seen on an image, cells that are trying to repair themselves in addition to doing their regular job.
“MTBI can occur not only from serious direct head trauma but also from multiple minor head injuries or even injuries with no direct head contact,” Waldrop said.
Waldrop said that growing evidence has linked repeated concussions to dementia later in life and that people younger than 15, in particular, need to be careful, because their brains are still developing.
“If your brain is injured during a certain point in development, you may lose a skill that you never pick up again,” Waldrop said. “As a child develops, there are specific skills gained at specific ages, and if your brain is not fully active at that stage, you may lose the skill.”
Although the clinic accepts older patients, Waldrop estimates that 75 percent of the concussion clinic’s patients are young athletes. He said that every season, there is at least one concussion in every high school football game played in the United States. But the risk of concussion is not limited to football players.
“It’s estimated that, of all the high school athletes, 20 percent will have a concussion in any particular season,” Waldrop said. If they play sports for four years, there is a very good chance that they will eventually suffer a concussion.
The clinic conducts assessments of the patients’ cognition, vision and vestibular system, which affects balance.
Waldrop said those tests are necessary for a thorough evaluation.
“No single test predicts recovery,” he said. “There’s [neurocognitive] ImPACT testing, vision testing, balance testing, cognitive performance — all of these things that have to be assessed before you can return to play.”
To provide what Waldrop called a “one-stop shop” for concussion patients, the clinic’s medical team includes physicians, physical therapists, exercise physiologists, registered dieticians and speech and language pathologists.
Waldrop emphasized the importance of ImPACT testing to establish a baseline of medical data for athletes in case they need to be tested again, after a concussion.
When Kristy Schnabel’s 17-year-old son, Stephan, was knocked unconscious while playing lacrosse, she was unsure how long to wait before allowing him to play again. A registered nurse, she was aware of the growing concern about the cumulative effects of concussions on long-term health, and she had received differing medical opinions about how long he should stay on the sideline.
After examinations and consultations with the concussion clinic’s medical staff, including a series of physical and cognitive tests, her son was cleared to play.
Stephan Schnabel had been tested before his concussion, because his school, Middleburg Academy, requires students to complete ImPACT tests before participating in sports. This gave the clinic staff information that helped them determine that he was ready to play again.
Loudoun’s public schools have also begun ImPACT testing of high school athletes.
Not all of the clinic’s patients suffered concussions while playing sports.
Leesburg resident Abigail White, 14, was recently diagnosed with POTS, a medical condition that caused her to have fainting spells. Her mother, Darlene, said that Abigail had suffered three concussions after fainting and hitting her head on the ground.
The clinic conducted tests that helped distinguish between symptoms that resulted from POTS and those that were caused by the concussions. Abigail takes medication to help control POTS and received information about how to protect her head in case of fainting spells, Darlene White said.
“It was good to know that once we got the proper care and got the proper education on how to treat it, she recovered perfectly fine,” she said.
The clinic’s staff also conducts outreach to educate the community about concussions by speaking to groups of school nurses and trainers and at gatherings of youth sports league participants and their parents.
“If you can begin the education early with the parents, the schools and the physicians . . . the more likely the athlete is going to come clean and say, ‘Hey, I’m not right; something’s wrong here,’ ” Waldrop said.