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By James Hufnagel

Niagara Falls is a competitive city filled with spirited people, so it's no surprise that our youth take to rough-and-tumble contact sports with vigor and enthusiasm.

Whether it's Niagara University hockey, lacrosse at Niagara County Community College or Wolverine football, or one of the numerous sports programs participated in by hundreds of local youngsters, access to modern, comprehensive sports medicine programs offered by Niagara Falls Memorial Medical Center greatly benefits the community.

Even when playing by the rules, sports injuries occur. A clean football tackle, a good hockey check, even an unintended fall or collision during a pick-up basketball game can result in what's called "traumatic brain injury" or concussion.

According to the Centers for Disease Control, an estimated 135,000 children and teens between the ages of 5 and 18 suffer a traumatic brain injury during sports activities in this country annually.

The medical establishment has recently taken a second look at concussion, newly recognizing it as a serious medical condition requiring appropriate diagnostic and treatment procedures, as opposed to past practice, when a young athlete was more often than not advised to "shake it off" and get back in the game.

At the forefront of the new emphasis on concussion is Tony Surace, NFMMC's director of Sports Medicine at its Competitive EDGE Sports Performance facility, located at the hospital's Summit Healthplex in Wheatfield. The Concussion Clinic run by Surace at that convenient location is one of only two in all of Western New York, the other being at the University of Buffalo.

According to Surace, the medical approach toward concussion has changed significantly over the past couple years.

"It used to be, 'Do you have a headache? Do you have dizziness? Nausea? How do you feel?' Those are the standard symptoms someone may have when suffering from a concussion," said Surace, who also serves as the Memorial-affiliated athletic trainer at Niagara Falls High School. "On average, it takes two to three weeks before it is safe for someone with typical symptoms to return to activity."

Concussion is defined as the immediate and temporary deterioration of mental functioning due to trauma. Athletes who have ever had a concussion are at increased risk for another concussion, and children and teens are not only more likely to suffer concussion than adults, but also take longer to recover.

Few scenarios are scarier to parents and coaches than concussion as it occurs on the playing field.

"Basically, the brain impacts one side of the cranium (skull), and now it's injured," Surace said. "Whether it's a football player, gymnast, motocross ... when someone takes a hit to the head, symptoms may include headache, nausea, or even loss of consciousness. Sometimes the symptoms start to appear the next day, but that's rare. Usually the signs appear immediately. When symptoms appear, the athlete must be pulled."

"Before the new guidelines, some athletes would say, 'Well, I just have a little headache. I am perfectly fine,' and they won't tell the coach, the doctor, their parents or their athletic trainer. And if they continue to play, and suffer a second hit to the head, it can be fatal. That's why when someone is symptomatic, they cannot return to the game," said Surace.

What makes patient management at the NFMMC Concussion Clinic unique is its utilization of thorough and comprehensive evaluation and treatment procedures, based on the latest medical research and guidelines of the National Institutes of Health, Washington, D.C., and the American Medical Association.

After sustaining a concussion, the patient is usually referred to the clinic by their primary care doctor, pediatrician, emergency room physician or coach, although walk-ins are welcome. An evaluation is done with a physical therapist, assisted by the athletic trainer and a physician -- a trio of healthcare professionals assessing the athlete. Neurocognitive functioning is exhaustively evaluated, sometimes by computer-based testing, and results compared with standard scores or, ideally, baseline values previously obtained from the patient.

"We'll do balance testing, neurocognitive testing, memory testing, exercise testing, symptomatic questions. We'll measure physiological parameters like heart rate and blood pressure, and check their cranial nerve assessment, and record everything.

"We don't start the exercise protocol until they are asymptomatic, meaning until they feel fine, which may be a certain number of weeks. We'll give them a home exercise sheet to follow. We progress them daily.

"The first day, they will do 20 minutes of aerobic exercise on the treadmill, just to get their heart rate up. The second day, they do the treadmill and then weightlifting. The third day, we may possibly allow return to practice. The fifth and final day, we'll see how they do and may let them return to play.

"Basically, the protocol is rest. We tell them to try to get as much rest as they can. Sometimes we will pull them out of school for a week or two weeks to let them, essentially, rest their brain. Any cognitive activity, whether they are taking tests, reading a lot, or using a computer, may exacerbate the symptoms of concussion," Surace explained.

Surace raises particular cautions when it comes to medicating concussion. He warns that even taking a simple medication like Tylenol should only be done with physician approval, since it may mask symptoms that are relied upon to monitor the patient's progress.

Niagara Falls Memorial Medical Center has been serving the Niagara Falls community since 1895.

Niagara Falls Reporter www.niagarafallsreporter.com June 28, 2011