Schools, trainers, physicians and other providers work together in Moffat County when a child or teen suffers a concussion.

When Frani Jenkins came to work in Craig about 7 years ago, she brought with her a wealth of knowledge about concussion injuries that led to a revolutionary collaboration between physicians, athletic trainers, physical therapists and the school district.

Jenkins, a Certified Athletic Trainer and a Physician Assistant, has been in sports medicine for 33 years, with more than 20 years in rodeo sports medicine. She began talking to the then-director of the physical therapy clinic in Craig who shared her concerns about youth concussion injuries, and they also included the athletic director at Moffat County High School, local physical therapists and physicians. The talks were the earliest stages of what’s now known as the Craig-Concussion Action Team (C-CAT), which also collaborates with and includes members from the Moffat County School District’s Traumatic Brain Injury Team.

“We really felt that the strength of our organization was having input from many different entities who especially dealt with concussed students of all ages,” she said.

Concussions are so dangerous because they involve both physical and neurocognitive symptoms. The C-CAT stays current on national and international research to make sure local concussion treatment protocols incorporate the latest evidence-based research, Jenkins said.

“It’s a need that every community has, not just here,” she said.

The dangers of concussions

A concussion is a form of traumatic brain injury in which the brain suddenly moves back and forth, causing a disruption in function, according to the National Injury Prevention Foundation. It’s often caused by trauma to the head, but it could also be caused by violent shaking to the head or upper body.

There are more than 62,000 concussions every year in high school contact sports, according to the American Association of Neurological Surgeons. “Estimates show that between 4 percent and 20 percent of college and high school football players will sustain a brain injury over the course of one season,” according to the American Association of Neurological Surgeons. “The risk of concussion in football is three to six times higher in players who have had a previous concussion.”

People with concussions often can’t remember what happened immediately before or after the injury and may act confused. A concussion can affect memory, judgment, reflexes, speech, balance and muscle coordination, according to the American Association of Neurological Surgeons.

Research shows that the brain is still developing into a person’s mid-20s. Children who have had one concussion are more likely to have a second one, said Dr. Kristie Yarmer, a pediatrician at Memorial Regional Health, and second concussions that occur close to the first can have devastating consequences.

“That makes it particularly important to ensure full recovery after a concussion, as it helps prevent future concussions and avoid cumulative damage from repeated concussions, Yarmer said.

Marshall Kraker, one of Moffat County School District’s Certified Athletic Trainer who also works as an Athletic Trainer with Memorial Regional Health Sports Medicine and as an Athletic Trainer in concussion rehabilitation with Memorial Regional Health Physical Therapy, said the C-CAT tries to educate students and parents on all of these dangers.

“One concussion might not completely debilitate a kid, but multiple ones throughout school can have detrimental effects,” Kraker said.

Parents of concussed children sometimes don’t fully understand the dangers of the injury. Jenkins said she often hears parents claim they hit their heads many times as a child and turned out fine — that their child just got his or her “bell rung.”

“One of the things we run into is the length of time it can take for a kid to return to full activity, full sports and full academics,” she said. “One requirement is you have to be back in class with no academic accommodations before going back to athletics.”

This recovery can take 3 to 4 weeks minimum, she added.

Collaborative treatment

The C-CAT involves school athletic trainers, physical therapists, the school nurse and other medical providers so identification and treatment of concussions are always done thoroughly and collaboratively. Yarmer said the team ensures that appropriate and timely diagnoses are made and that academic accommodations are made when appropriate. Memorial Regional Health asks parents to sign a medical release form when a child comes in for evaluation for a concussion so that the healthcare providers can communicate with the school nurse, teachers, physical therapists and athletic trainers about the injury.

“It truly is a model for cooperative care,” she said.

That communication allows these folks to better monitor the children and teens after their injury. Teresa Laster, Moffat County School Psychologist.

“We get referrals from the doctor’s offices and then we monitor them with a checklist to see if they’re having struggles or if they’re having trouble in the classroom,” Laster said, adding that recovery periods are different for each student and also depend on the severity of the injury. “We’ve really worked very hard with the community, schools and physicians to work together with these kids to make sure they get back on track as quickly as possible.”

Yarmer said treatment often starts with short days at school, with supports such as rest breaks, limited computer time, extended periods of time to return schoolwork, and shortened work assignments.  

“As symptoms improve as the student is able to tolerate more activities, often times a referral for concussion rehabilitation is made,” she said. “This is a protocol typically through physical therapy or the athletic trainer.”

One of the many tools used in treatment plans is baseline testing, in which student athletes are given a computerized test that assesses balance and brain function, including learning and memory skills, ability to pay attention or concentrate and how quickly the student can solve problems. The results, according to the Centers for Disease Control and Prevention, are compared with results from a similar exam after a student gets a concussion.

Kraker said the testing can be useful, but he likes to incorporate other methods, as well.

Perhaps the most important concussion treatment and management tool in Craig is this collaborative effort to care, he said. It’s something for which the school district and the C-CAT are incredibly proud.

“We’re pretty ahead of the game to have a functional team with quite a few individuals that provide a communal approach to concussion management,” Kraker said. “If you don’t have this group planning, how can you expect to be successful?”