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Zackery Lystedt inspired WA State's concussion law, the Lystedt Law

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Head U Concussions





Anatomy of a Well-Managed Concussion…

and yes, it's baseball season

Catcher Preston McFarlen was good at his job, so when the pitcher’s curve ball kept out-maneuvering him, he knew somethingPreston was amiss. The previous inning a foul tip had struck his mask, but not hard, and then as unlucky as it seemed another one hit the same spot a few moments later. That one he felt. He shook it off, was questioned by the umpire and aside from a bent facemask, seemed none the worse for wear. But that changed. What happened next is a tribute to the Lystedt Law (see home page) and the work of those who made it a reality for all youth athletes in WA State.

How It Unfolded

Preston is not only a great baseball player, but an outstanding football player as well. Under the Lystedt Law, he and his teammates have been trained about the dangers of continuing to play with a concussion. Last spring, Preston, his coaches, parents, and teammates attended a concussion workshop at his high school featuring Dr. Stan Herring, Co-Medical Director of the Seattle Sports Concussion Program, and a Seattle Seahawks and Mariners team physician. So when he walked into the dugout and told his coaches he couldn’t go back into the game, he had everyone’s full support.

Friday night, March 26: Preston’s mother Penny hears the ball hit her son’s mask and the sound reminds her of football helmets colliding. It takes a few minutes, but Preston starts feeling nauseous, dizzy, he develops a headache, and most noticeably, his depth perception is impaired, which is why he is having trouble at the plate. Putting two and two together, he takes himself out of the game. On the way home, his mother reaches the on-call nurse from their doctor’s office, and inquires as to whether he should be seen right away. “Preston’s symptoms subsided about two hours after he was hit, so the nurse didn’t feel he needed to go to the hospital. Most of his headache had dissipated, and he still had some residual sensitivity to light and noise, but he had definitely improved,” says Penny.

Sat morning, March 27: Preston’s dad, Bill McFarlen, a football coach who has recently completed another concussion training course, takes him to their local doctor who spends approx. 45 minutes evaluating him. By this time he is symptom-free, but the doctor asks that he make an appointment at the Seattle Sports Concussion Clinic before he returns to play.

Monday, March 29: Preston takes a computerized neuropsychological concussion test (in this case ImPACT). The results are sent to a local orthopeadic surgeon and then hand-carried by Preston’s family the following day to the Seattle Sports Concussion Clinic along with his baseline results which were acquired 8 months previously at his high school.Preston

Tuesday, March 30: Preston sees Dr. Scott Laker at the Seattle Sports Concussion Clinic. He has been symptom-free now for 4 days, and Dr. Laker recommends that he not participate in a game until he retakes the ImPACT test and he and neuropsychologist Dr. David Coppel (see feature story) have a chance to evaluate the results. However, he can start a supervised, gradual practice schedule, which he does, and remains symptom-free.

Wed. March 31: Preston takes stats during a missed game. (see photo)

Monday April 5: Preston takes the ImPACT test for the second time post-injury and receives clearance from Dr. Laker and Dr. Coppel to play in tomorrow’s game.

Tues April 6: Preston plays in his first game since his concussion. He has been symptom-free for 10 days, and his only activity has been a graduated return-to-play program established by his doctor and monitored by Preston, his coaches and parents.  He catches the full game, hits well, and remains symptom-free.

What Worked

  1. Preston was educated enough about concussions to realize he had suffered one and removed himself from the game

  2. His coaches and teammates were also educated about concussions and knew to evaluate him frequently in the dugout, looking for signs of subsequent deterioration

  3. Preston’s parents knew he needed medical attention and a medical clearance, when appropriate, before he could return to play

  4. His local doctor gave him a thorough evaluation, and referred him to specialists

  5. He had taken a computerized neuropsychological test (ImPACT) to establish a baseline 8 months earlier

  6. He was able to retake the ImPACT test quickly and have the results sent to qualified medical professionals for interpretation

  7. Preston was able to see the concussion specialists a few days after his injury

Preston and his family were thankful the doctors at the concussion clinic were able to see him right away. Program Manager of the Seattle Sports Concussion Program and the UW Medicine Sports and Spine Physicians, Sandra Thompson, is keenly aware of the need for urgency. “We intentionally leave several appointments open every week for athletes who have suffered concussions. We know most want to return to the game as soon as possible, so we need to evaluate them quickly and give them a clear idea as to when they can safely return to play.” 

Prior to the implementation of the Lystedt Law in July 2009, it’s unclear whether Preston’s concussion management would have followed the same course. But it’s evident that concussion education for all involved played an important role throughout the entire process of Preston’s recovery. The Lystedt Law will save lives, there’s no doubt about it. And it takes the guesswork out of the concussion recovery process by putting the return-to-play decision in the hands of qualified medical professionals, where it belongs.


 
 

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