From soldiers on the battlefield to professional athletes on the football field to kids on the soccer field, concussions have become a popular subject for debate. Rosemarie Scolaro Moser, Ph.D., ABN, ABPP-RP, is an expert on the topic and the many ways in which it can affect these diverse groups.
Dr. Moser, director of the Sports Concussion Center of New Jersey and the RSM Psychology Center, is a licensed psychologist, certified school psychologist and a board-certified neuropsychologist and rehabilitation specialist. “I was always intrigued by how the brain works,” she says. This fascination led her to receive her doctorate from the University of Pennsylvania. She is an internationally renowned expert in the field of sports concussion, a former president of the New Jersey Psychological Association and of the New Jersey Neuropsychological Society.
In 1995 she opened the RSM Psychology Center in Lawrenceville, N.J. The center provides psychological and neuropsychological services, including treatment of depression, anxiety, posttraumatic stress, panic, phobia, family and marital conflict and adjustment to life changes for patients ranging from school-age children to older adults. Its team of educators and researchers has helped the center become nationally recognized for its expertise in the assessment of learning disorders, attention deficit disorder, brain trauma and dementia.
“When I became a mother with kids in sports I was aware of how their brains are being shaken up,” Dr. Moser says. “I was interested in research going on at that time in professional sports.” She began her own youth concussion program in the 1990s and by 2009 was providing so many concussion-related services that she opened the Sports Concussion Center of New Jersey (SCCNJ).
SCCNJ offers education about concussion, consultations to teams and individuals, and baseline and post-concussion testing for schools, teams and sports organizations. Baseline testing provides a snapshot of the patient’s skills most likely to be affected by a concussion, including memory, speed, reaction time, attention and concentration. “We keep their baseline test results on file so should they sustain a concussion in the future,” she says, “and we can compare post-concussion test results to their baseline results to help us determine when they are able to return to sports.”
Dr. Moser suggests this evaluation be performed on all children ages 10 and older and repeated annually as the brain grows. “Many injuries we see are from play, rough housing and accidents on the playground or bikes, as well as those related to organized sports.”
Concussion is the most common form of head injury for athletes. According to Dr. Moser it can be caused by receiving any significant force to the head, and this includes not only being struck but also sustaining whiplash. It is marked by an alteration in consciousness, which can be as simple as feeling dazed, and can be associated with immediate disorientation, amnesia, confusion, visual disturbance, headache, and in some cases loss of consciousness, among other concussion signs. Symptoms may not be evident for hours or even days.
Following a concussion the brain is in a rather fragile state until fully healed. It is during this time that an infrequent but catastrophic “second impact syndrome” can occur. “If the patient returns to play too soon and sustains another hit, it can cause a further devastating event, impairment or even death—which can happen very quickly,” she warns. “In general, returning too soon may prolong recovery and symptoms may last longer.” These symptoms can include headache, fatigue, irritability, memory problems, slow mental processing, and poor attention/concentration, which, if they persist longer than three months, can be considered a post-concussion syndrome.
Time to Heal
Rest is currently the standard form of treatment for concussion patients but, as Dr. Moser points out, “The brain can never be shut off. If you fracture your arm you can put it in a cast, but the brain functions 24 hours a day.” The goal of rest is to reduce the patient’s cognitive and physical activities as much as possible. This includes allowing no schoolwork, reading or computer use, along with limited or no television—in other words, no activities that require intense visual or mental processing as well as no physical activities such as exercise and chores.
“One of our research studies looked at healthy students,” Dr. Moser continues. “Those who had two or more concussions reported more symptoms—cognitive and physical—than those who had one or none at all.” She says it is essential that anytime a concussion is suspected the patient seek medical assistance and not return to play until cleared by a medical professional with expertise in concussion evaluation. This requirement is now a state law for school sports programs in both Pennsylvania and New Jersey, thanks to the efforts of many concerned sports concussion specialists including Dr. Moser and the team at SCCNJ.
Dr. Moser worked with U.S. Rep. Bill Pascrell Jr. in his concussion initiatives, which now include The Youth Sports Concussion Act of 2013 that ensures that new and reconditioned football helmets for high school and younger players meet safety standards that address concussion risk and the needs of youth athletes. She also serves on the Centers for Disease Control and Prevention’s Pediatric Mild Traumatic Brain Injury Panel, helping to develop guidelines that will be coming out in 2014 and has been awarded the American Psychological Association Presidential Award for Advocacy in Psychology.
In addition to education, research and baseline testing, SCCNJ provides monitoring of a patient’s physical and cognitive rest, biofeedback for headaches and stress management, supportive counseling services and post-concussion testing, including physical exertion tests conducted by its athletic trainers who help determine when it is acceptable for an athlete to return to play. RSM Psychology Center works in tandem with SCCNJ to provide comprehensive services that go beyond recovery. If there are enduring effects from a brain injury, the Center’s staff members provide evaluations, suggest accommodations that should be made at school or work, and send their professionals to schools to provide training for how to offer these accommodations to develop educational plans for patients. Many athletes also suffer from learning or attention (ADD) disorders and there are often emotional components associated with concussion that can be addressed by psychotherapy.
“Each concussion, and each student, is unique,” Dr. Moser says. “There is no cookie-cutter approach to bringing students back to school. We modify their programs from week to week. Even when they return there may still be symptoms. Some bounce back but others struggle. We help to transition them until they are fully recovered.”
In addition to providing services through SCCNJ and RSM Psychology Center, Dr. Moser has written a guide for parents. Her latest book is “Ahead of the Game: The Parents’ Guide to Youth Sports Concussion” by Dartmouth College Press. “While treating and managing youth athletes, parents often told me they wished they had known more before it happened,” she says. The idea for this book sprang from the desire to provide parents with all of the information found in the SCCNJ handouts and more. “The format is readable and user friendly but offers the most up-to-date information that parents and athletes need to know. If you read it, you will know more than most pediatricians or primary-care physicians do about concussions and how to best protect your child.”
Because of her expertise on the topic, Dr. Moser was also invited to participate in a documentary film by “MomsTEAM,” an organization dedicated to the needs of sports parents. This film, “The Smartest Team,” chronicles the school year of an Oklahoma football team that invited Dr. Moser and other experts to minimize the risk of concussion-related injuries of their players by designing educational and interventional programs. She believes it is an important tool for educating athletes, parents and coaches in the prevention of sports related concussion, and it is also “dedicated to making football safer.”
“Here at our center our motto is ‘Love your brain, love your sport,’” she says. “If you take care of your brain, you will be able to play better and longer.”
Sports Concussion Center of New Jersey at RSM Psychology Center LLC
3131 Princeton Pike, Bldg. 5, Suite 110
Lawrenceville, NJ 08648
609-895-1076 or 609-895-1070
Photograph by Rob Hall