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Cohen tells story as Flisser, task force unveil concussion ’10 Best Practices’


Dr. Miriam Levitt Flisser and Scott Cohen


Scott Cohen never set out to be the poster boy for post-concussion syndrome, but it’s a role he has come to embrace. Why? Because he’s seeing positive change when it comes to high schools dealing with concussion victims both on and off the playing field.

Cohen, a Scarsdale High School junior, attracted quite a bit of media attention earlier this month following a press conference at the Westchester County Executive offices in White Plains in which County Executive Rob Astorino and Dr. Mark Herceg, the county’s health commissioner and leader of the Westchester Concussion Task Force, unveiled their “10 Best Practices” in a neatly packaged concussion awareness pamphlet.

Cohen, who missed the first two months of high school as a freshman and struggled the next 10 to get back to his pre-concussive state, shared a much briefer version of his story than has been told in the Inquirer last year, but the message was clear: recovery time differs on a case-by-case basis, and in Cohen’s case that recovery took a year’s time, in part because the types of “return to play”

10 Best Practices

1) Start with awareness: Formally educate parents, student-athletes, coaches, appropriate school personnel and youth sports programs about the symptoms, risks and proper treatment of concussions.

2) Build a team: Encourage schools and youth sports organizations to have a designated concussion management team (CMT) that brings together experts trained in concussions. The team should meet or communicate regularly. At minimum, the CMT should include, but not be limited to, an athletic trainer, physician, nurse, athletic director and school/neuropsychologist.

3) Report what you know: Ensure that all concussions are reported along with any lasting symptoms from the field or playground to parents, first responders, medical professionals, school administrators and teachers. Concussions do not just happen in a game; they can happen in gym class or at recess.

4) Assess situations immediately: Use athletic trainers to conduct sideline assessments that can be compared to baseline behavior, in order to capture concussions in real time as they occur.

5) Don’t “one stop” shop for answers: Districts and youth programs should provide referrals to specialists (neurologists, physical therapists, neuro-ophthalmologists, neuropsychologists), as needed, to treat specific symptoms. One provider should not be the “one stop shop” for all symptoms.

6) Understand the big picture: Ensure everyone involved understands the impact a concussion can have on the behavioral, academic, emotional and physical maturation of young children.

7) Stay current: Health care providers evaluating children and adolescents must maintain a current level of understanding in the area of the diagnosis, treatment and management of sports-related concussions.

8) Encourage training: Ensure that properly trained professionals, such as athletic trainers, are available to conduct sideline tests and that the results are reviewed and interpreted by a neuropsychologist or school psychologist.

9) Beware of single answers: Schools, youth programs, parents and students need to be aware that concussions are a clinical diagnosis, and that it takes more than a single or brief computerized test to understand the extent of an injury.

10) Focus on return to learn: As important as return to play is for a child, it is more important that schools have a return to learn plan (RTL) to address issues children face as they return to the classroom after an injury. Returning to the classroom does not always parallel returning to play.

— Westchester County Concussion Task Force (full booklet at mentalhealth.westchestergov.com/images/saferconcussions/)

and “return to life/learning” protocols were not in place two and a half years ago after he suffered a concussion during football training camp in August 2013.

“A lot of my teachers didn’t really know how to deal with a kid who had a concussion, which was completely understandable,” Cohen said.

Neither did his family. “Discovering what was wrong and what was the problem was very, very hard for me,” said Cohen, who suffered from many symptoms including headaches and an inability to comprehend his math lessons.

Eight months after his concussion, Cohen sought neuropsychiatric treatment from Dr. Jay Dunkle, who is on the task force formed last summer. Cohen made great strides in his recovery under Dunkle’s care, though he still had a long way to go.

The one thing Cohen knew when all was said and done was, “I didn’t really want to be done with it. I felt something positive had to come out of my experience.” And so he urged Chris Nowinski and the Concussion Legacy Foundation to make him a student ambassador, he started a concussion club with some of his Scarsdale High School friends who also had bad experiences and also worked his way onto the task force as a student representative late in the process.

In response to the Newton, Connecticut, shootings, Astorino developed the Safer Communities initiatives. The first focus was active shooter responses, and others include absenteeism in schools, suicide prevention, crisis intervention training for first responder, administering Narcan for heroine overdoses. When it came to Safer Sports, Herceg presented the idea of focusing on concussions first.

“Despite advancements made since the passage of state law in 2011, Mark explained that the response among schools was sort of uneven and that there were gaps, especially when it came to post-injury follow-up,” Astorino said. “He was speaking as a father as well as a professional who spent a lot of time on the sidelines. I connected immediately not only as a father but as a coach for CYO basketball.”

In addition to the best practices are common myths and facts, signs and symptoms, concussion danger signs, return to play guidelines and a list of resources. Astorino wants the information used “from grammar school to graduation and beyond.”

Dr. Miriam Levitt Flisser, the former Scarsdale mayor who is hard-pressed to turn down a chance to serve the public, joined the task force following a concussion seminar held in August by the task force. Flisser is the medical director for the Bronxville School District and is on the school’s concussion management team.

“My school district is generally a leader,” Flisser said. “One of the reasons I attended the meetings was to be sure of our leadership position and to make sure we had everything in place. And we certainly do. It’s always good when newer things come up to be in touch with the cutting edge. Staying current is No. 7 on the list of advice given by the task force. It’s good to take current things back to Bronxville and for every school district.”

Flisser is proud of the county’s concussion pamphlet. “I think it’s a tremendous example of good government,” she said. “The government sees an issue, gets experts together and then produces recommendations for the smaller communities to implement. I’m impressed with the results.”

Flisser enjoyed expanding her list of contacts to include many she has met through the task force, and especially likes having the task force’s recommendations as extra backup should she meet any resistance in her work.

“One of the newer things is return to learning, which is not as structured as return to play in any school district because it is a newer outlook on it,” Flisser said. “It’s something that can be reviewed and improved and we will all continue to do that.”

With 20-plus years’ experience with Bronxville and working with high school students, Flisser has seen major changes from the “bell ringing” days to the present, but most of that change has been recent. “Many years ago, not in recent memory, students would get hit during a game and someone would say he got his ‘bell rung,’” Flisser said. “No follow-up would ensue. That’s all gone now. That was changed rapidly as this science developed and also the knowledge of what this can do in the long run.”

Herceg has worked in brain injury rehab and sees “gaps in concussion care,” noting this is “vital in ensuring that children return to life as healthy and as soon as possible.” Based on the data his office collected and was studied by a student from New York Medical College, most local high schools do well, but the weak ones lack collaboration and being up to date with information when it comes to concussion care.

“We know concussion information is rapidly changing,” he said. “What we know now is very different from what we knew 6 months ago. It’s important that providers and schools make sure they do not prescribe or distribute outdated information, that they keep their protocols up to date.”

Herceg said some high schools in the area are behind the ball when it comes to having a diverse enough concussion management team.

Upon seeing the top 10 list for the first time the day after the press conference, Scarsdale athletic director Ray Pappalardi and Edgemont A.D. Anthony DeRosa, who took over there when Pappalardi came to Scarsdale this school year, said the main thing their respective schools will look to step up is parent education. In that regard, the booklet is a good tool for both schools to use in the education process.

Pappalardi noted that most of what is in the Top 10 list is in the state guidelines from the New York State Public High School Athletic Association — essentially state law for high schools to follow.

“For Scarsdale, I think the Scarsdale Parks and Recreation Committee and director of recreation have to be sure that the structure is in place for a child that has been injured during recreational activities that are nonschool-related,” Flisser said. “I think the schools have good structure in place. What’s really lacking, what we really have to emphasize is children who play in rec leagues and travel leagues, make sure the structure is in place, that it’s in place there. It’s just as important if they get hurt there. It’s not just the school.”

Astorino and Herceg know this plan is geared more toward school districts who have the resources to educate and handle concussion protocols, though they hope youth organizations, which are mostly parent-run, can take the message and the information and use it to make their programs safer.

Youth sports leagues don’t have trainers or medical staff, so Astorino wants volunteers and parents to be educated, to know what to look for.

“We’re not expecting coaches who are volunteers as parents to make a medical diagnosis,” he said. “This isn’t what we want, but if a child is injured on the court or in the field, there needs to be attention to that — and a serious attention to that. Take them off and do some basics and probably the best thing is with any doubt, leave them out of the game and make sure the parents follow up and follow up with the school so the teachers can observe in the classroom to see if the child is having some continuing problems.”

This “complex subject” isn’t meant to scare, but to educate, according to Astorino, who said he wants “kids playing sports all over Westchester County. It’s good for them for a whole host of reasons.” He added, “We don’t have all the answers and we certainly are not going to insert county government into an area that it doesn’t necessarily need to be in. The primary responsibility lies with parents and school officials. Our goal is to play a helpful role here.”

In advance of the big unveil, and included in the booklet, are endorsements from the Brain Injury Association of America and the Brain Injury Association of New York State.

Astorino wants this to be an ongoing effort, so the next step, he said, is studying data as far as frequency of concussions, gender differences and recovery time.

The county’s booklet will be sent to Westchester native and current resident Roger Goodell, the commissioner of the National Football League. “Obviously this has been a very big topic with the NFL and all of sports, but I think he’d like to see our good work here in this county,” Astorino said.

Astorino was asked about the feature film “Concussion,” starring Will Smith as Dr. Bennet Omalu, the first to diagnose chronic traumatic encephalopathy (CTE) in former Steelers great Mike Webster. Astorino noted he wasn’t sure what was fact or fiction as far as the film was concerned, but said, “I don’t think that, and maybe this comes as the football fan that I am, that the NFL should be getting a black eye on this. They’ve made strides, important strides. They also have a product that America absolutely loves. Unless they’re going to change to touch football there’s going to be injuries, but how they deal with that is important.”

He also said, “This is not an NFL issue, this is not a football issue. This spans all different sports, all different levels, including cheerleading and many other sports that may not get the attention because everyone thinks it’s just football.”

Read more local coverage of your hometown in this week’s issue of The Scarsdale Inquirer. Newsstand copies are available at several locations listed above, or subscribe today for convenient home delivery.


January 29, 2016