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// CONCUSSION CONTINUED FROM PAGE 24 ////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////// // MEETING BY DESIGN CONTINUED FROM PAGE 22 who is in his 31st year in Hanover. "We communicate with certain sections of the group more regularly than others," he says. "But even with them, there are things going on that may have an effect on how we handle situations. It is helpful to be made aware of what everyone else is working on that is either potentially in conflict or could help a particular situation." Or as Miller, the strength coach, says: "Meeting like that gets everybody on the same page. The coaches are right in front of everybody and can say, 'We would like this, this and this.' "That way the nutritionist knows what they're talking about. I know what they want and need. The leadership people know that. We all come together. It makes everything seamless." The DP2 meeting is time well spent, Anne Hudak says, because no one operates in a vacuum – or should. "It is very helpful to know what is going on in different areas of an athlete's life because their lives are interconnected. If they are not doing well in one area or something is bothering them, it is going to effect them academically. It is going to affect them athletically. Being able to sit down and talk to that many people and connect the dots is extremely helpful. It's how we learn how to best help them move forward. "It is about helping the students succeed and hopefully making the lives of the coaches a little bit easier at the same time." Which is one of the things it does according to Wielgus, now in her 28th season in Hanover. "Winning and losing is clearly important and that cannot be minimized," she says. "But the fact of the matter is that we are developing kids beyond that. Meeting this way has crystallized for me the effectiveness of DP2. It is very specific. Everyone has a voice and is heard, from the trainer to the conditioning coach to the nutritionist. It makes me feel I am part of the team working to make things better for the kids. "I'm not big on meetings but that is one of the most productive things we've ever done. We sit and we talk about the student-athletes in many different ways. It's clear there is a bigtime educational component to what we are doing and that Dartmouth is looking out for the spirit, mind and body of athletes." Tests are read by a DHMC neuropsychologist after which Karlson, who considers an eye-tracking nystagmus test particularly helpful in making the final call on return-to-play, will render a decision. "I really try to push the athletes to be honest about their symptoms because they want to play so they aren't always as truthful as they should be," she says. "Balance testing? Semi-objective. ImPACT test, the neurocognitive test? Effort dependent. Symptoms? Completely by patient report. "That's why I like the eye test. You can't fake it." It goes without saying that there's never a good time for a concussion, but given the advances nationally and at Dartmouth in diagnosing and understanding the problem, it's a better time now than ever before. "We know a ton more than we did 10 years ago but there is still an awful lot that we don't know," says Frechette. "Everything that we do and the way we treat people is based on a consensus of best opinions by the experts. "I am proud to say the Ivy League was at the forefront of this. We were thinking about this and really started doing some of this neuropsychology testing with our kids before a lot of the schools around the country did. "I think it's good that people are talking about it and I think kids are getting better care as a result of it, although it can't prevent concussions from happening." The Preventive Piece When he was a senior quarterback for the Big Green in the 1978 season, Dartmouth football coach Buddy Teevens suffered a concussion in a game at Holy Cross. "I didn't know where I was," he said. "I was out of it. But the norm was, suck it up and keep going." Times have changed and so has the game. "It's much more physical and aggressive than it was," Teevens said. "The athletes are bigger and faster. From my day to now it's a completely different game." Which is why Teevens not only has embraced Ivy League's year-old rule that limits full-contact practices to two-a-week, but has taken it a step further. Between spring practices and the entire 2012 season, Dartmouth ran fewer than two dozen tackling plays in practice. "Some people find fault with that and think it is detrimental to your development as a football player," he said. "A lot of these kids been playing football since they were five- or six-years-old and they all played high school football. They know how to tackle. They know how to be tackled. "We had maybe three, four, five concussions this year, not a lot compared to the way it was in the past. The days of 13, 14, 15 during the course of a preseason are over. We've got to guard against them as coaches." In addition to restrictions on football contact and the reviewing of dangerous tackles, the Ivy League addressed the concussion issue in soccer, where an Ivy report listed the incidence of the problem in the women's game as being even higher than football, and in lacrosse, where another study had the men's game behind only football. There's now a limit on the number of days when men's lacrosse teams can body check as well as a limit on when women's teams can stick check. As in football, coaches have been instructed to work with their athletes on safe and proper techniques and teams are now required to have officials visit practice to address rules adopted to make the game safer. "All of this is healthy," said Amy Patton, Dartmouth's longtime women's lacrosse coach. "Our game has made a tremendous leap as far as speed and skill, and that has lent to a little bit more, I wouldn't say playing out of control, but swinging when they shouldn't. "We're also more aware in practice where we've seen balls tipped off a stick and hit the head. We're better about making sure we have the kids in a safer place." Which is exactly what Dartmouth, the Ivy League and the NCAA are trying to do across the board. P E A K | WI N TER 201 3 29