Mind & Spirit

Protecting Young Athletes at Monroe Clinic

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Our young athletes face the possibility of a number of traumatic injuries while playing sports. Learn how a local health system is helping them to recover quickly — and safely — from sports-related trauma.

Communities throughout Green and Stephenson counties look to Monroe Clinic Hospital in Monroe, Wis., for diagnostic and medical care. That’s a given. But Monroe Clinic has a mission to provide care beyond the examination room, too.

Founded by the Congregation of Sisters of St. Agnes, Monroe Clinic is guided by its mission to create healthy communities through God’s healing spirit. This often takes the form of building partnerships and encouraging connectedness in the northern Illinois and southern Wisconsin communities it serves.

One example is Monroe Clinic’s approach to the growing field of sports medicine, especially as it pertains to youth. In response to increasing concerns of parents, schools and the medical community, Monroe Clinic introduced the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) program nearly five years ago, and is a credited impact consultant (CIC) center.

A concussion is any disturbance in brain function after a blow to the head or violent shaking. The nationwide annual incidence of sports-related concussions is estimated at 300,000, according to the ImPACT organization.

Area high school football fans may recall seeing Eric Katzenberger, a licensed athletic trainer at Monroe Clinic, standing on the sidelines and running onto the field when an athlete is injured. He says concussions on school playing fields are no more prevalent today than they were in the past, but are now better recognized and more aggressively treated.

“ImPACT was developed by the University of Pittsburgh, a leader in concussion management,” Katzenberger explains. “It’s a software cognizance program that helps us to give our student athletes the best possible care from the first instant to finish.”

Today, more people, especially parents, are aware of the problems that can result from head trauma, because of recent media coverage about professional athletes who have suffered in various ways and even committed suicide after repeated concussion trauma.

“ImPACT is used by football, baseball, basketball, hockey and other professional teams to assess their players,” Katzenberger says. “In partnership with the school districts in Green and Stephenson counties, we pre-test every athlete before school starts, using ImPACT software to establish a baseline cognitive pattern. Should a head injury occur, we then have the data we need to compare normal brain response to what’s happening with the concussive trauma.”

Katzenberger describes concussions as the “invisible” injury.

“When a player is down on the field or comes off of it limping or holding an arm, it’s easy to tell where the injury is,” says Katzenberger. “But a player with a concussion is not as likely to run to the sideline. Concussion diagnosis requires close attention to a player’s appearance as well as what he or she might tell me. There are 10 signs we look for, and 10 symptoms we observe by talking to the athlete.”

A student demonstrating signs of concussive injury may appear dazed or stunned, forgetting, for example, the last play. He or she may not be sure of the score or even who the opponent is. In addition, athletes might move clumsily, answer questions slowly, show signs of personality change or forget events prior to or after the hit.

Upon questioning, the student may complain of headache, nausea, loss of balance, dizziness, double or fuzzy vision, increased sensitivity to light or noise, sluggish or foggy feelings, memory problems or changes in sleep patterns days after the injury.
With the ImPACT baseline as a guide, it’s easier to determine not only the extent of the concussion, but also what stage the athlete is in throughout the healing process.

“ImPACT differs from an MRI or X-ray in that we might see physical damage, but not cognitive or processional problems,” Katzenberger explains. “The kids may tell us they are fine, but we withhold judgment until we have the ImPACT data in hand. The standard time needed for concussion recovery used to be two weeks without playing. Today, we take each case individually. Some students might recover more quickly, while others may need more time before their ImPACT scores are back to normal.”

Monroe Clinic’s neurology department also takes a proactive role in helping young athletes recover from concussions.

“Through our concussion clinic, we devise a custom treatment plan in which we may stop the athlete from using a cell phone, taking tests, playing computer games or other activities that require significant brain function,” says Katzenberger. “They may be told to rest in a darkened, quiet environment for extended periods of time to encourage healing. We may even recommend they not drive, because of possible impairment to their cognitive judgment through affected vision, depth of field or impaired decisionmaking.”

Despite recent news reports about concussions, some parents and students still don’t take the injury seriously enough. Dr. Joshua Morrison, a Monroe Clinic neurologist, says that people who suffer one concussion are more likely to be concussed again, and with cumulative damage.

“During football season, we see school athletes between the ages of 10 and 18 in our clinic every Monday at 4 p.m.,” Morrison says. “We use ImPACT as an adjunctive to physical examination to determine when it will be safe for them to return to play. Kids tend to trivialize symptoms, but ImPACT confirms, in 90 percent of cases, when the healing process is complete.”

Ideally, Morrison would like to see every child tested during the summer, not just athletes. Head injuries can happen anywhere a child is playing, whether he or she is climbing a tree, riding a bicycle, swimming and diving, swinging, using a teeter-totter or something else. With an ImPACT baseline on record, doctors have a useful tool to diagnose and successfully treat each individual’s concussion. Individual athletes pay $10 for the ImPACT baseline assessment; however, school districts can participate for a $500 fee that covers all of its athletes. ImPACT tests are funded at cost, or at a loss, making them a community service.

Morrison emphasizes that a condition called post-concussion syndrome affects an unknown number of student and professional athletes. Chronic headaches, fatigue, sleep deprivation, personality changes, short-term memory and problem-solving challenges are among symptoms that may be experienced. While these symptoms are disabling on their own, even more alarming is the fact that the syndrome can lead to catastrophic neurological damage, in the case of second-impact concussions. Between 30 and 40 deaths can be attributed to post-concussion and second-impact syndromes each year in the U.S.

“The danger in coming back to the game too early can’t be overstressed,” Morrison says. “Even if a child fully recovers, there’s still a little higher risk. We advise a student to rest, rest and rest some more, while their brain mends. If that means staying out of sports and gym classes, so be it. I mean, if professional athletes who are being paid big bucks are told to sit out games in order to protect them from post-concussion and second-impact syndromes, why should anyone allow children to go back before they are fully recovered? Kids and even parents sometimes have too casual an attitude toward what is truly a serious condition.”

Concussion management is just one of many Monroe Clinic outreach programs, some offered at low or no cost. Athletic trainers Brittney Hansen and Abby Haldiman are members of the sports medicine team that provides assessments and covers events not only for 14 area school districts, but also at other community activities and events.

“We conduct injury assessments twice weekly for all contracted school districts,” Hansen says. “That includes follow-up exams as well as additional visits if the need is urgent.”

Although school coaches normally handle conditioning, the Monroe Clinic team is available to offer advice and answer any questions they may have.

“We host a two-week athletic assessment program each summer at the Green County Family YMCA,” says Hansen. “During this, we analyze how athletes ages 12 and older jump and land. This is a performance enhancement camp focused on proper jumping, landing and agility techniques to reduce the risk of new injuries. The camp starts and ends with the drop jump test to assess how great of a risk each athlete is at before and following the camp. Participants are videotaped to evaluate and correct moves to avoid ACL injuries. We also do this in schools, if we have enough participants.”

The cost for assessment sessions depends upon the setting and number of athletes participating, Katzenberger explains.

Sports physicals are another aspect of sports-related education and prevention. Contracted schools hold these for middle school players and sophomore/varsity high school players; freshmen are required to have a full physical prior to starting the school year. Haldiman sends out email reminders for the physicals, which cost $20 per athlete. Part of that fee is donated back to the school district.

“We try to get these scheduled before summer sports camps,” Haldiman says. “That way, students are on track for a safer school year, and have time to make any corrections to be able to compete in the fall.”

Monroe Clinic also strives to educate parents on the potential dangers of heat-related injuries, by scheduling pre-season meetings before football training begins, says Katzenberger. He stresses the importance of adequate hydration and cooling measures to avoid illness.

“We also take a team approach to any effort,” Katzenberger adds. “We meet regularly to improve the programs and community coverage. During any event coverage, it isn’t just athletic trainers who are on hand, but also our doctors. In that, Monroe Clinic differs from many other medical centers.”

For clinic caregivers, providing the best care possible isn’t just a job. While it’s necessary for them to charge fees for certain services, they also volunteer their time and expertise. Case in point is Dr. Robert Cates, a family practice and sports medicine physician at Monroe Clinic-Brodhead.

“I came to the Monroe Clinic in 1990 and I’ve always been into sports,” Cates says. “I went to the high school to volunteer and have been doing that for the past 22 years. It’s fun to be a part of the school sports programs and to get to know the kids. Plus, I’m doing something I love and it’s a way to give back to the community.”

Cates goes to Brodhead High School each week during practice sessions to check up on athletes.

“Then I go to the games,” he says. “Not only are they fun to watch, but I’m convinced the parents appreciate my being there for their children. It doesn’t matter who is injured during a game. I run out when an opposing player is down, too.”

Cates says it takes time and effort to build rapport with the young athletes, but when they understand he is there to help, they warm up to him.

“They don’t want to be told they can’t play,” Cates explains. “But once they trust me, they understand I have only their good at heart. Then they let their guard down. And they learn that I’m one of their biggest fans, too.”

Cates played sports in college and now has children who play college sports. He knows how it feels to be restricted from play. While some doctors take out a player for the whole season, Cates works closely with coaches to figure out the best possible way to help each athlete fully heal, without sacrificing more playing time than necessary.

“They appreciate that I know the difference between a minor injury and one that needs more care,” Cates says. “Our mutual goal is to get the kids healthy as soon as possible, so it’s safe for them to be back on the playing fields. The ImPACT program is part of that goal to not only ensure our children are protected, but also to raise public awareness of the seriousness of concussion injuries.”

Cates volunteers for Monroe sports programs, too, covering football, basketball, soccer and wrestling meets. He notes that other Monroe Clinic doctors and staff members also donate time and expertise to dozens of community-related events.
As a Congregation of Sisters of St. Agnes-sponsored ministry, the clinic is committed to making the world a more caring place, says CEO Mike Sanders.

“We do this by bringing the best health care to our communities and being responsible stewards of our planet’s resources,” Sanders says. “The opening of our new hospital this spring was a major step in this endeavor. Our patients don’t have to look far to find a trusted friend in health care. The opportunity for a more caring world is as close as the person standing next to you.”

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