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00204 DEC.

20, 2013 JILL OLSON, PHYSICAL THERAPIST & OWNER OF PEAK PERFORMANCE PHYSICAL THERAPY, LAUNCHED THE DYLAN STEIGERS CONCUSSION PROJECT IN 2010 00:17 Interviewer talking 00:48 How did you become involved with the Dylan Steigers project? 00:54 We’ve always been very passionate about sports medicine at Peak Performance Physical Therapy, and in February of 2010 I sent three of my physical therapists to a nationwide sports medicine conference, and they had attended several conferences on working with concussions and blast injuries with both athletes and concussed soldiers, because we are seeing so many blast injuries with explosive devices with our soldiers as well, so there’s a lot of research that’s going into both our athletes and our soldiers, and they came back and they said that everything we’re doing with concussions is wrong, and we really have to bring Missoula up to speed and up to the gold standard, with how to handle sports medicine injuries with our athletes. And they said it’s going to be hard because the coaches aren’t going to like to hear about what we have to say, parents aren’t going to like to hear what we have to say, and even doctors are not going to like to hear what we have to say because it’s so different in how to handle concussions before, because prior to that they maybe ran a CAT scan, doctors might run an MRI, they might pull them from the game, they might run a few tests on them and say ‘oh, we think you’re ok, you just had a ding, you just had your bell rung, you can go right back to play, not seeing many major symptoms, you should be ok’, well what we know now is that if you have any of those symptoms, and there’s a list of over 25 symptoms, that include nausea, dizziness, sensitivity to light, sensitivity to noise, ringing in ears, um…difficulty sleeping, memory, focus, concentration dysfunction, balance dysfunction, um, the list goes on and on, if you have any of those symptoms at all then you most likely had a concussion. You could have one of those symptoms and have a concussion. You could be hit somewhere else in the body and that blow to the body could have a rebound effect to the head and you could have a concussion not even know it. So we know now that it takes one of those symptoms to diagnose a concussion, and that concussions can’t be diagnosed by a CAT scan or an MRI. And we also know that a concussion is a chemical storm inside of the brain. It’s a structural, or it’s a functional, it’s a chemistry dysfunction that takes place inside of the brain, and it can’t be picked up on a CAT scan or an MRI. And on the minimum, it takes seven to ten days for that chemical storm to clear, and that’s where we’ve learned now that you’ve got to give that minimum time for that chemical storm to clear. If you don’t the brain’s really vulnerable, and if you return them to play too soon, then their chance of having additional concussions within that time is highly-much higher than it is without a concussion because their brain’s really vulnerable. We also know that young athletes have much softer brains than the older, more seasoned athletes, and our veteran athletes, and so they’re extremely vulnerable. We’ve seen multiple,

multiple young athletes come in and say ‘I had my bell rung, got hit in the head, not sure if I had a concussion, nobody really saw it, coach didn’t do anything, the athletic trainer didn’t really do anything, went back to play, got hit again, then I was really sick and nauseated and really dizzy, I have a hard time seeing or focusing, um I’m trying to go to school and I can’t focus, I have really bad headaches, and um then I went to practice the next day and was just running drills and I got hit again, and now I can’t do anything,’ that’s three concussions within three days, I mean we get a lot of those kinds of stories, and they’re horrifying, because we know now how vulnerable those brains are, and they’re not being identified, they’re not being acknowledged, that that ‘just that bell ring’, just that ding is truly a concussion and they have to be identified immediately and managed accurately from the get go to give that brain the full healing that it needs. So we started in 2010 I said, when my therapists came back from this conference, I said we’re in. Peak Performance is behind this, we’re going to make this happen fast, we’re going to bring Missoula to the gold standard as fast as we can. And, of course, we had a lot of resistance from coaches, that’s like ‘what do you mean I have to pull my player out for seven to ten days? I’m going to sit them on the bench, I’m going to lose my whole team, My hockey players are getting dings all the time, if I have to pull every player out that had a ding, I’d have no one to play’. And parents were irate, coaches were irate, it was highly hyperemotional as we started to start this education, and we got Dr. Schaeffer, John Schaeffer, he’s a neurologist with Montana Neurobehavioral Specialists on our team, and we said we need a neurologist (5:39) to read everything we’re going to put out, all the documents that we put out, our brochures, for education to make sure we’ve got your gold stamp of approval and that everything we’re producing is correct, and he said, ‘I’ll do it, but nobody’s going to want to hear what I have to say, and I’ll see every athlete, you know, as soon as I can, I’ll get them in immediately, but they’re not going to want to hear what I have to say, I won’t let them play for, you know, a minimum of a week until that brain heals’, but he said, you know, I’ll do it. So we started just pouring out brochures and pamphlets and educations, and meetings with teams, and schools, and parent teams, and coaches, providing all the education we could, and then we put on seminars for physicians and health care providers, and the first thing Dr. Schaeffer said to the doctors was, you know, ‘look, look, doctors, everything we learned in school is wrong, from what we’ve learned before from what we know now is all wrong. We have to relearn how to handle concussions’, and so we were really able to bring Missoula up to the gold standard (6:42) in a really fast and efficient way, and the Dylan Steigers- well then we launched the Dylan Steigers Concussion project in um…March of…two thousand…well probably February of 2011, and um, it was a very tragic event when Dylan Steigers passed away in May of 2010, he was a phenomenal athlete, he played for Sentinel High School, and he graduated in 2006, and he was an amazing football player, legendary football player there, and looking back now his parents will say that he had multiple concussions, and he…he…he would refuse to report his symptoms, because he didn’t want to be pulled from play, so he’d hide a lot of his symptoms, he’d ignore his symptoms, deny his symptoms, because playing football meant everything to him, there were times when his athletic trainer at Sentinel High School would lock his football helmet up just to keep him from playing, and we know now about post-concussion syndrome (7:47) and that’s when you have a concussion that doesn’t completely heal, or you have a concussion and then you have another concussion on top of the first one and those symptoms don’t completely heal, then you have long-term symptoms like…long term problems with attention and focus and concentration which can lead to depression and anxiety, and irrational behaviors, and anger outbursts, and then you start to see

problems with grades, and your grades start to drop, and then you have more problems with anger and anxiety, and irritability. And looking back, Dylan’s parents said, ‘you know, we saw a lot of those symptoms, and we didn’t really relate it to his concussions, but we really think now that he struggled a lot more with post-concussion syndrome than we ever realized.’ And then Dylan went on to play football for Eastern Oregon, and in May he was in a spring scrimmage and he took a blow to the head and walked off the field and um, struggled with some disorientation, and then um, started vomiting profusely, fell to the ground unconscious, and then they life flighted him to Boise, Idaho (8:54) and he had a subdural hematoma- an internal brain bleed- and he was on life support for about 24 hours, and then he passed away. So it was a very tragic event, and he didn’t die from a concussion, it was a much more serious internal brain bleed, but it was um, such a tragedy, and we, um, months later talked with the family to see if they would allow us to name our concussion project after Dylan and they were really honored, and they have been so passionate about teaming up with us in educating our Missoula athletes and um, Montana athletes about concussions, about educating them, and providing them with baseline testing, the impact testing, the neurosite testing, and working to protect them from further concussions. So we launched that in…I guess it was 2010 when we launched it, and since then (9:50) we have tested over 1000 area athletes, we have baseline testing on over 1000 athletes, and we’ve helped manage over 300 concussions to help provide them with the safest and most efficient return to school and return to play that we can. (10:07) 10:08 So you do believe that concussions are a bigger deal than people have made them in the past? 10:16 Yes, very concerned. It’s a mild traumatic brain injury, and every time I present to any audience, young or old, I always start out by asking ‘who in in this audience has had a concussion?’ and maybe um, three, five people will raise their hand. And then I’ll say ‘who had, you know, their bell rung, just kind of had a ding, had your clock rung?’ and probably 25 hands go up in the audience, and then as I give the education on what concussions are that anyone who has had this list of symptoms, you’ve had a concussion, and they’re just floored, ‘I had a concussion, no I just had my bell rung, or clock dinged,’ and I’m like no, that, we know that now is a concussion. You had a mild traumatic brain injury, you had these symptoms, you had this whole chemical storm go off inside of your brain, and it’s a functional injury, it’s not a structural injury, and that’s a concussion, and then when I go on to give a list of the postconcussion syndrome symptoms that you continue to have with migraines, and difficulty with focusing, concentration, memory, and irritability, from long-term symptoms that haven’t completely healed then I’ve got people flooring me afterwards, ‘I think I’ve got some of that, I, you know, I need to talk to you more about that, I continue to play hockey, and every year I was just thinking I was getting my bell rung, but I’m getting multiple concussions, yearly, and it’s compounding, and I can see this compounding effect,’ and we also know that people that have a…that struggle with migraines and attention deficit prior to their concussion usually can have bigger impact of um, greater migraines and greater symptoms afterwards, they have a bigger propensity to post-concussion syndrome afterwards, so they’re starting to link a lot of these other issues with brain and concussions in the brain’s ability to rebound and heal afterwards, so (12:10) research is coming up with new things all the time. And we’re finding that as they

look at all these NFL players and professional hockey players and those that have donated their bodies to science they will literally, after they die, they will study their brains, and they will take slices of that brain and look at that brain under the microscope and they’ll see buildup of protein in their brain, there’s a protein called a towe protein and it looks like these little brown specs under a microscope, and that towe protein then starts to cloud the brain and it resembles, um, something very similar to Alzheimer’s and dementia, and that’s what’s causing a lot of this, this dementia that we’re seeing in our pro football players, and they’re actually seeing some dementia in some 17 year old football players now from the cumulative trauma (13:00) of these, um, these hits that these young players are taking over and over. 13:05 So do you think, um, do you think that maybe the baseline testing should be implemented at an earlier age, rather than just high school eventually? 13:17 Absolutely. And our goal is to have it in all the middle schools. And we hope to have that accomplished within the next year. 13:23 Well and especially with like Little Griz , I mean, they get pretty rough … 13:31 Yep. And we’ve been testing both the Little Grizzly teams and the Missoula Youth Football teams. 13:36 Conversational banter…blah blah blah. 13:48 So um, how did the law come about then? 13:52 Well, unfortunately Missoula’s pretty late in getting that law, I think we’re like the 45th, or 48th state to incorporate a law, but I’m really proud that we got it done. And um, the Dylan Steigers Concussion Project was real influential in both in creating the protocol in Missoula, the statewide protocol here, or the citywide protocol, and how to safely handle concussions, and then we had um, several speakers from our committee in Helena frequently meeting with the governor, and speaking at panels, and providing information and research on our Missoula protocol and meeting with different boards and governing bodies, and in providing education and influence in getting that law passed. 14:40 So you said that um, concussions can’t be diagnosed by a scan, so how can they be diagnosed then? 14:47 Um, it can’t be diagnosed with a scan, because it’s not a structural injury, you can’t pick up bleeding, you can’t pick up…we used to think you could pick up little microtears and bleeding and torsional injuries in

the brain, and that’s more of a moderate traumatic brain injury, so it’s still important to have CAT scans and MRI’s to pick up a moderate traumatic brain injury, but a mild traumatic brain injury, it’s a chemical injury, and that doesn’t show up on a CAT scan. There’s more advanced technology, and more advanced testing that’s really expensive that they’re coming up with, with blood tests, and with other um, highly complicated tests that are starting to diagnose concussions, and we don’t have access to a lot of those in Missoula right now, they’re expensive, and they’re starting to formulate those, but we do know it’s a chemical disruption in the brain. So we know it’s the symptoms that you identify with a concussion. And it’s the whole list of symptoms, I brought the concussion management manual that we put together, the DSCP. And we have a list of all of these symptoms, physical, you can read those right there. Go ahead and read those. 15:57 Reads the list 16:50 So what does the baseline test do in terms of um, helping prevent or I guess…what do they do to help with the concussion? 17:02 The baseline is just a small part of our overall program and how we manage concussions, but it’s a neurosite test and it takes about 30 to 45 minutes and it assesses your attention, concentration, focus, reaction speed, um, those types of things. So it gives a baseline of your ability, your score, when you’re functioning, hopefully, at a normal function, hopefully you’ve had a good night sleep, you’re feeling good, and you’re functioning at your normal and then if you were to have a concussion, we’d bring you back in and you take that same test and we have how you function at normal and how you function after a concussion. And then we can compare those two scores. And we want to see those scores come back to within your normal limits before we start moving you back into physical activity and physical play. 17:51 And um, how do we know those are accurate in terms of the results? 17:56 There’s a lot of scientific research that goes into that, they have a lot of normative data impact has poured so much research into that, that it’s, there’s always some fallacy within the numbers and it’s one of many tools that we use, it’s not the only tool. We always, we also do a whole neurological assessment. So we look at your balance, and test all your cranial nerves, and we look at your visual eye tracking and we look at your coordination, we do a sway balance test, which is a computerized balance test, and that compares your balance to the normative data of all of your peers your age and your abilities, and so it’s one of many tests we do, and it just gives us, the beauty of that is it’s your personal test, at your baseline, compared to when you’ve had a concussion. So, that’s the beauty of the impact test.

18:49 And you said that you were facing a lot of push back from coaches and parents, what was that like for you? 18:56 Um, you know, we expected it, and we anticipated it, but with everything knowledge is power, and with education, and unfortunately with um, repetition of injuries, when they could see what a concussion looked like, the more they could see that with more experience and they could start to understand it, and it just took a few bad concussions, a few repeated concussions for coaches to see what happens when you return a player to play too soon, and it’s like oh, now I get it, now I see what’s going on. We would have um, athletes and parents come in and the parent would say I think my son is just faking it, he doesn’t want to go to school, and he just wants to stay home and watch TV, and he doesn’t like school anyway, I think he’s just faking it. And then the son would say I just don’t feel good, my brain is just wacked out and I can’t focus and concentrate and I don’t want to, I feel like I just can’t even play football right now, my parents think I’m faking it but I don’t feel good. So then you come in and take the post-concussion test and his scores were just tanked, and he comes out of that test like a deer in the headlights and he’d have this raging headache and then we could take the scores to the parents and say this is what’s going on. This is what happens with a concussion, everything your son is telling us is exactly what’s going on. This chemistry storm is like hurricane Sandy in his brain right now He’s got this flood over here, crashing waves over here, hurricane over here, and that’s why he can’t concentrate he can’t focus, he’s really irritable, and he can’t go to school, he can only go for half days let’s get him into half-days, he’s sleeping all the time, he needs that, he needs some rest, and here’s the plan, he goes to school for half days, he doesn’t, well he’s just trying to get out of chemistry because he hates chemistry, no, when he goes to chemistry his brain’s working so much harder than it is in his easier classes so we only want him going to his easier classes for half days and he can do that without a headache, and all these other symptoms come down then we can get him into full classes, once he’s in full classes for full days and he’s feeling better, then we can move him back into his athletics at a really modified ability, we’ll come back, we’ll run the test again, we also put him through exertion testing, where we have a real controlled amount of exercise where we monitor heart rate, blood pressure, and we put them through a really controlled amount of aerobic exercise to see how their brain responds, and if they can get through that without increasing their symptoms, if they can’t, then we have to keep them at that controlled level until their brain can accommodate and allow for that level of activity. So it’s a real controlled and guided return to school, return to play program as the brain is healing. Because if you do too much too soon the brain can’t handle it and then you keep them in those levels of symptoms longer, but with the right amount of guidance then we can progress through the healing process faster, and efficient, more efficiently and then hopefully prevent post-concussion syndrome which is the long-term lasting headaches and migraines, that is just a sticky mess.