As the national buzz about the dangers of concussions has escalated in recent months, Bowdoin Athletics has faced an increase in the number of concussions among athletes this fall.
While Head Athletic Trainer Dan Davies acknowledged that the number of concussions does fluctuate from year to year, he suggested that this year's increase in diagnoses may be a result of larger media coverage regarding concussions in the past year.
Despite the increase, the College has not changed its approach in dealing with concussions. The diagnosis and treatment process begins on the field.
There is an athletic trainer present during the practices and games of all collision sports, which include football, men's rugby and women's rugby. Other sports are equipped with an emergency kit and a radio.
"You can see all of the other fields from [where the trainers are stationed], so if something goes wrong, we can be there quickly," Davies said.
Dj Darden '12 of the women's rugby team was one of the athletes who suffered a concussion this fall. During an October game, she was punched in the face by an opposing player using what she described as a "close-fisted stiff-arm." She fell to one knee and stayed there as the trainer came out on the field.
Davies said that if an athlete presents symptoms of a concussion, a trainer performs an on-field evaluation and asks standardized questions. If an athlete is diagnosed with a concussion, NCAA rules state that the athlete is not allowed to play or practice on the same day of the diagnosis and cannot play again until he or she is cleared by the team physician.
"The key with concussions is that it appears that [if] the second one...happens before the first one has been cleared [it] does the most damage," said Director of Athletics Jeff Ward.
The on-field evaluation is crucial to avoiding second concussions, but Darden was not diagnosed with a concussion at the time of her injury. Though she was enduring intense pain, Darden told the trainer that she was fine and did well enough on the evaluation to continue playing. She played for the majority of the remaining time.
"I thought I was fine. I didn't feel dizzy...I just felt angry," she said.
The symptoms of her concussion did not manifest themselves immediately. She was having trouble concentrating on homework the day after the game, but did not realize the seriousness of her condition until two days later.
After getting a headache during her first class, her vision became "very blurry," and during her second class, she noticed that her hearing became "muffled." She described it as a terrifying experience, and immediately went to see an athletic trainer.
When athletes complain of concussion-related symptoms, one of the first steps is to take Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) and the Balance Error Scoring System (BESS) test. In order to set a baseline for an athlete's balance and cognitive abilities all athletes must take the tests before their first and junior years. Athletes' scores on the tests relative to their baseline are one of the major factors in determining the extent of their concussion.
After meeting with a trainer, Darden was told to cease all strenuous activity and referred to the Health Center for an appointment the next day. All athletes who have concussions must meet with a physician at the Health Center to set up a treatment plan and determine academic status during the recovery period. Students with concussions are often held out of classes during the early stages of recovery.
"The preferred treatment as we know it now is that we put students on brain rest for at least two days," said Director of Health Services Sandra Hayes.
In most cases, brain rest primarily consists of sleeping. Students are advised not to read, look at a screen, listen to music or engage in physical activity.
"The first day, I appreciated the sleep," said Darden. "After that, it was really boring."
Hayes acknowledged that complete brain rest is very hard, especially on a college campus. Not only are students very connected to technology, but loud roommates and neighbors can also exacerbate concussion symptoms. As a result, Hayes often suggests that students who live close to campus go home for more effective brain rest.
During brain rest, athletes who stay on campus go to the Health Center every other day so that a physician can gauge recovery. They also meet with the athletic trainers every day to fill out a symptom sheet.
While some students recover with only two or three days of brain rest, others require a more prolonged treatment. Hayes said that the extended period is hard for both students and professors. Students may get frustrated with themselves because they have no control over their speed of recovery, while professors do not always understand the full effect that a concussion can have on a student.
Depending on the seriousness of the concussion, the student's academic performance and the time of the semester, brain rest for more than a week can have serious academic consequences. While students are not penalized for the time they miss, they are advised not to do homework while on brain rest, which makes it easy to fall behind on work.
"After the first week, if the student is still on brain rest, I talk to them about the potential [for dropping a class or taking a medical leave]. Then, after two weeks, we involve the Dean's Office more directly," said Hayes.
As students recover, the return to full academic status is gradual. Students are often encouraged to attend classes for half of the class period and are discouraged from attending classes that rely heavily on PowerPoint presentations. As their symptoms diminish, students eventually return to classes full-time.
The return to full athletic activity requires a five-step process coordinated by the trainers' office. In the early stages of recovery, athletes do agility work and either bike or run. After passing those two steps, they retake the ImPACT and BESS tests. When they return to their baseline, they are allowed to participate in light contact and then are eventually cleared by team physician Dr. Lucien Oullette to participate in full contact.
According to Hayes, athletes also must have returned to class full-time before they are able to play.
Athletic eligibility depends on when the student was injured. Ward said that if the injury occurred in the first third of the season, athletes are able to regain that year of eligibility.
The athletic training staff has been very conscious about employing up-to-date concussion research in their treatment protocol.
"We've been on the cutting edge of concussion management for the last five or six years," said Davies.
The Athletic Department has also attempted to provide teams with the best equipment available to limit the risk of concussion.
While rugby players have very little protection because of the nature of the sport, the football team wears Ridell Speed helmets, which are used by both NFL teams and the majority of the top-25 D-I football programs in the NCAA. Ward said that research has shown that the Speed helmets have proven to be most likely to reduce the risk of concussion, and the Ridell website advertises that their helmets provide a "31 percent reduction in the risk of concussion" compared to traditional helmets.
Athletes are also advised, though not required, to wear vacuum-mold mouthguards, which Davies said has also proven to reduce the risk of concussions.
Ward said that the Athletic Department has also made education about concussions one of its top priorities, saying that he wanted athletes "to understand that what used to be considered a headache might now be considered a concussion."
One of the most important aspects of the concussion education campaign was a video on concussions shown at the beginning of the year to all athletes and faculty members. Davies said that the video was meant to help students understand when they might have a concussion and inform professors about the recovery process.
Raising concussion awareness among athletes has been especially important, as research has shown the long-term damage that a concussion can cause.
"You can fix an ankle, you can fix a knee, you can fix a broken bone, but brain damage is permanent," said Davies.
"[We're trying to] get people to understand that it behooves them in the long term to totally get rid of the concussion," Hayes added. "You only get one brain."