Cheerleader’s injury reveals complexity, dangers of concussions

Posted April 03, 2011, at 4:47 p.m.
Last modified April 03, 2011, at 5:28 p.m.

Olivia Doyer hit the ground, hard.

One moment she was flying, tossed 20 feet into the air by her Poland Regional High School championship cheerleading teammates during an after-school practice. The next moment she was falling. The feel of the ground instead of the arms of her teammates was the first fleeting surprise.

Then the 17-year-old heard a crunch like a soda can being crushed.

“Without realizing it, my hands flew to my neck and I just held my neck and tears pooled in my eyes. I didn’t open my eyes, I didn’t move besides that because I truly thought I’d been paralyzed,” Olivia said.

She wasn’t paralyzed, but neither was she OK. A doctor would diagnose Olivia with a cervical sprain and disc impingement, according to her family. If a concussion was considered, the possibility was all but dismissed by everyone involved. She hadn’t blacked out, wasn’t nauseous or experiencing blurry vision. Her neck was the big problem.

Except that it wasn’t.

In the year since her fall, Olivia has struggled with post-concussion syndrome, the aftermath of a traumatic brain injury. At times she couldn’t turn her head without getting dizzy or sit in a room without being bothered by the light or read more than a couple of lines in a book without the pressure in her head building to an agonizing level. She slept a lot. It was the only time she wasn’t plagued by pain.

A year later, Olivia’s gradually healing, but her life remains far from normal. Once an honors student who planned to become a math professor, Olivia is now going to high school only part time and taking only the most basic classes. Once an accomplished cheerleader who thrilled crowds and wowed judges with her acrobatics, she’s now happy to be able to make it up a flight of stairs by herself.

Recently, as Olivia sat in the audience, dark sunglasses protecting her from the room’s light, her mother urged lawmakers in Augusta to approve a bill that would require Maine schools to have policies on the management of head injuries. Olivia and her family want hers to be a cautionary tale.

“When students get a concussion, they think you get a bump on the head,” said Olivia, now 18. “They don’t realize how, if it keeps developing or if you get one bad enough, it’s going to affect your everyday life like it does mine.”

A cheerleading life

Concussions are a type of traumatic brain injury that can occur any time the brain is shaken. Although people often get concussions due to a blow or a fall, any major body jolt — even one that doesn’t result in a bump to the head — can cause a concussion. Post-concussion syndrome is more likely to happen in someone who has had multiple concussions within a short time.

Children and teenagers are at greatest risk for concussions, and they take longer to heal once they get them.

Olivia began cheering in fourth grade. She had just moved to Mechanic Falls with her family, and her new friends were on the local recreation team. She had adored dancing as a young child, and cheering was a similar activity — but with the added thrill of a crowd.

“I instantly fell it love with it,” she said. “[It was] exciting and very challenging. There’s always something new. I loved the choreographed routines and the stunting.”

Petite, enthusiastic and good with balance, Olivia turned out to be the perfect “flier.” When a stunt called for a cheerleader to be tossed in the air, she was often that cheerleader.

“It was so much fun. Exhilarating. It was something you feel confident at and good at,” she said. “It was frightening at times when the stunt would be shaky, but in the moment where it hits, it’s like scoring the final point at the buzzer at a basketball game. Every time you hit it.”

Olivia’s bedroom quickly became filled with cheerleading photos, medals and certificates. She joined her middle school team and an elite all-stars team, traveling out of state for some competitions. Her little sister started cheering. It became a family affair.

“Like the hockey families, you have cheer families,” said Olivia’s mother, Roxanne Doyer. “You go to the hotel and stay, and pinch pennies to save to go to all these things for them, but that was their chosen sport.”

Of course, stunts sometimes went wrong. Cheerleading can be as dangerous as football, experts say. But none of the stunts that Doyer saw seemed to go catastrophically wrong, and no one seemed concerned at all about head injuries.

“The first time I saw it was at the all-star level, where the intensity was greater. I’d see other stunts come down, so to speak, where you as a parent just hold your breath. But it was treated at the time so lightly. The girl got up and then she started up again,” Doyer said. “I guess it was a fleeting moment of panic that somehow seemed to resolve in your mind as the girl, on the outside, looked OK.”

Olivia wasn’t immune from getting hurt. There were minor bumps and bruises along the way. Then, one day during a summer cheerleading clinic when she was about 13, she landed on her back during a stunt. Her mother was watching from the sidelines.

“The coach wanted to let her sit for a minute and then put her back in, and I thought that was absolutely ridiculous. I wanted her to be assessed. It made no sense to me [not to]. So I took her to the hospital,” Doyer said. “That’s the first time I heard the word ‘concussion.’”

Doctors gave the family a list of problems to watch for, including sensitivity to light and sound. Olivia never exhibited any of them.

“She continued on with school and whatnot. She went on to another all-star gym. We did more competitions,” Doyer said.

By the time she was in her mid-teens, Olivia was a cheerleading instructor, guiding her sister and other younger cheerleaders at summer camp. She joined the Poland Regional High School team, where she remained a flier. The school required Olivia and her teammates to take a computerized neurocognitive test so the school would have a baseline to compare against in case any of them suffered a concussion later. Olivia took the test, but she said school officials explained little about it and there wasn’t much talk of concussions after that.

At the high school level, stunts were similar to those done by the elite all-star teams — bigger than those done at the recreation or middle school level. Injuries came more often. Especially last year. During her junior year, Olivia said, she got dropped an average of once per practice, often at a height of 12 feet or so.

“On my back, on my side,” she said. “Sometimes [the fall was] broken, sometimes not.”

It’s unclear whether any of those falls resulted in a concussion. The coach never checked her out, Olivia said, and Olivia never felt comfortable saying she was hurt.

“I just figured I should keep going,” Olivia said.

But when she seriously injured her knee during a badly planned stunt, she decided to speak up. Olivia said she voiced her concerns to a school official. When that didn’t result in noticeable changes and the accidents continued, Doyer said, the family wrote to school leaders and called the Maine Principals’ Association, the organization that oversees school sports and other interscholastic activities. Eventually, with more prodding by Doyer and others, Doyer said, the coach was replaced with two others in their early to mid-20s.

But the injuries continued under coaches Kathleen Hebert and Elizabeth Betsch, Olivia said. The team was winning and that seemed to take precedence.

“To be quite honest with you, I was afraid of my coach a little bit. She was intimidating. She never really assessed people [if they appeared hurt],” Olivia said. “It was understood, an underlying current, that you pushed through it.”

Both Hebert and Betsch declined to comment for this story.

Olivia rarely told her parents when she got hurt. About halfway through the season, after one particularly bad fall, she felt a lump at the back of her head. Not sure whether that was normal, Olivia casually asked her mother if she also had a bump there. Feeling her mother’s skull, she did find a small bump in the same area. Although her own lump was larger and sore, Olivia dismissed it. She didn’t consider a bump on the head to be serious. After all, no one at practice seemed worried when she fell.

“I just figured, ‘OK,’” she said.

Her mother, however, was concerned. But Olivia protested any intervention.

“I said, ‘Do you want me to go talk to your coach?’ She panicked [and said], ‘No, I don’t want to be taken out of my stunt,’” Doyer said. “She was all afraid that anything I would caution or question would mean removing her from her beloved sport.”

About a month later, the team won the Class B state championship. They were the only squad in school history to win a state title in any sport. It was their second crown in three years.

“It was a wild dream at the start of the season,” Olivia said in an interview with the Sun Journal at the time. “But after regionals I thought we had a good shot at it. And we just kept working.”

The team began preparing for the New England Cheer Championship. On March 15, 2010, days before the regional championship, one of Olivia’s practice stunts went horribly wrong.

The fall

Grades were about to close and students were dealing with a flood of tests, reports and projects. Everyone was exhausted, Olivia said. But the New England competition was coming. No matter how tired the cheerleaders were, the team had practice after school.

“It wasn’t a good energy that night,” Olivia remembered.

Several team members had commitments they couldn’t break, so they missed the first half of practice. By the time they got there for the second half, Olivia and other cheerleaders had already been practicing for over an hour. If they thought they were tired before practice, that was nothing compared to how they felt once their teammates showed up.

“Obviously, as a coach you’re worried your team isn’t looking good and you have to go compete at a New England level in a week. So she pushed all practice long. And then when the people who were missing earlier got there, the intensity was increased because now they were finally here, now we had to get going,” Olivia said. “So for those of us who had been there all night, we were spent. Exhausted completely from head to toe.”

But they practiced tossing and catching.

Tossing and catching.

Tossing and catching.

Stunts started to get shaky, Olivia said. People were injured, including Olivia — who fell about 10 feet to land flat on her back. Typically she popped back up after a fall. That time she stayed down a few minutes. She felt jarred, exhausted. She needed a moment.

The coaches, she said, didn’t say anything.

“I remember going out to the bathroom with one of my friends on our water break, and coming back I told her, ‘One of us needs to talk to coach. We need to tell her to let us do running, cardiovascular conditioning, something. No more stunting tonight,’” Olivia said.

But Olivia didn’t talk to the coaches. The team was quickly hustled back on the floor for more practice.

“At that point we were so exhausted, breathing was the main focus,” Olivia said.

In Olivia’s stunt group, something kept going wrong. She couldn’t get enough height, her form was off, her landings weren’t right. About 30 minutes before the end of practice, she fell and accidentally elbowed one of her teammates — a girl at the base of her stunt — in the forehead.

“She swelled and got an egg. Instantly,” Olivia remembered.

The coaches, she said, didn’t say anything. The girl stayed in. Practice continued.

About 15 minutes later, they began practicing a modified routine special for the New England competition. Olivia would be tossed 20 feet in air.

“I loaded in, they threw me in the air, I rotated twice,” Olivia said, “and I hit the ground.”

She landed hard on the inch-and-a-half thick mat. She heard a crunch. Her body flared with pain.

“I waited and about 30 seconds later my coaches came over when they saw that for once I wasn’t bouncing up like I always had before. They came over and asked me if I thought I was all right. I had no idea. I was hoping they were going to tell me if I was OK or not,” she said.

Olivia told the coaches she wasn’t sure, but she thought she might be all right. They asked if she thought she could get up.

“I was waiting for them to go get the trainer, who was in the building at the time. I’ve seen girls get hurt at a game before and the trainer makes them lie there and she fully assesses them, and I thought, ‘This doesn’t feel right. I feel like someone needs to tell me that I’m OK.’ But I figured they had seen it and it must not have looked that bad,” Olivia said.

She said one of the coaches helped her up, walked her to the sidelines and sat her on the floor. Then everyone went back to practice. There were five minutes left.

“They waited a minute, put on the music and the girls did the routine one more time,” Olivia said.

No one called the trainer, an ambulance or Olivia’s parents after she fell, Doyer said. Olivia walked out of the gym to meet her father for her regular ride home after practice. She was shaking and shuffling when she walked. She fought off tears as a friend dogged her and told her someone needed to call an ambulance.

“She said, ‘You’re not right,’” Olivia said.

But Olivia couldn’t think about anything but going home. Once through the gym doors she burst into tears. In the car, she told her father she’d been dropped.

Superintendent Dennis Duquette declined to comment on the details of Olivia’s accident, saying it was a personnel matter, a student matter and involved insurance companies. He did say the school system looked into the incident.

“She was caught. There are four spotters that’s all part of that and one of the spotters, their hands broke. Which means she was stopped but then she fell the rest of the way. I don’t know how far that was. Probably two or three feet,” he said. “I wasn’t there, but we’ve done a lot of investigation on it.”

Doyer vehemently disputes Duquette’s claims that her daughter was caught and only fell 2 or 3 feet. She said she has requested the investigative report be amended to correct portions she said are inaccurate, misleading or false.

At the hospital the evening of the practice, Olivia underwent tests to determine the extent of the damage. She ultimately got a hard neck brace and then a soft collar for what was diagnosed as a sprain of the vertebrae in her neck and an impinged disk.

Doctors told her to take it easy. Later that week she went back to school for half a day. She returned home pale and nursing a headache. That weekend, she and her family drove to Rhode Island to support her team in the New England competition. It was there that light and noise started to bother her.

Olivia deteriorated from there.

Although concussion symptoms might appear immediately, they can also take days, weeks or months, appearing just as the person goes back to the demands of regular activities. Soon, Olivia couldn’t balance well enough to walk up stairs. She battled vertigo and got dizzy whenever she turned her head. She couldn’t handle even weak light, was sensitive to noise and had memory problems. She was in constant pain.

Doctors diagnosed her with post-concussion syndrome. Experts say symptoms typically go away within a few months, though they can last a lot longer. Olivia’s have persisted for more than a year.

Paul Berkner, a medical director at Colby College in Waterville and president of the two-year-old Maine Concussion Management Initiative, said post-concussion syndrome typically occurs in people who happen to be genetically prone to the disorder, who have a history of migraines or other underlying neurological problems and who received multiple concussions within a short period of time.

Olivia has no idea how many concussions she might have had in the days or weeks before that last fall, or whether she was already concussed by the fall that caused her to land flat on her back earlier in that last practice. She was never assessed, she said.

Although Olivia’s getting better, her progress has been slow. She missed the last three months of her junior year and is only going part time her senior year. Because pressure in her head builds to agonizing levels whenever she does an activity that requires sustained concentration and cognition — such as reading — her parents have to read her homework to her. She can’t stand bright lights, particularly fluorescent, has trouble with her memory and still gets vertigo in crowded situations. Olivia had planned to go out of state to college, but instead applied to two local colleges because she fears she may have to live at home.

Because she doesn’t look sick, strangers often think she isn’t.

“This is a brain injury. Nobody sees it. She looks the same on the outside,” Doyer said.

The future

Olivia’s prognosis is good, but recovery could still take a while.

“They won’t give us any specific timeline. Everyone, including the neurologists, are all hopeful that she’ll eventually make a full recovery. But it’s like uncharted waters, so to speak. No one’s going to know until it’s years out,” Doyer said.

Recently, Doyer spoke in favor of legislation that would require schools to adopt a policy on the management of head injuries. Such a policy must require that students be removed from a practice, game or activity if they are suspected of having a head injury. The policy must also bar those students from participating again until the school has received written clearance from a medical professional.

The bill was sponsored by Rep. Donald Pilon, D-Saco, who was asked to submit it by a Portland neurologist with an interest in the issue.

“If a child has had one or two concussions, that will certainly impact their ability to learn in the future. So somebody needs be looking out for them,” Pilon said. “You have the coach that wants to win the game. And you have the child that has this peer pressure and wants to please mom and dad, and he doesn’t want to disappoint the coach. Then you have mom and dad that want Johnny on the field. It’s a lose-lose situation for the child.”

The Education Committee unanimously recommended the bill’s passage this week. At Doyer’s urging, it was amended to include the requirement that schools provide academic assistance to students who have a head injury — something Doyer said she has had trouble securing for Olivia at Poland Regional High School. The bill now goes to the full Legislature for a vote.

Although it would be a new state mandate, the bill isn’t completely breaking new ground. The National Federation of State High School Associations and the Maine Principals’ Association both maintain guidelines that:

• Tell schools to assess students for a concussion any time they hit their head;

• Say schools should pull students from the activity if there’s any question they may have a head injury and get them assessed by a medical professional;

• Say concussed athletes should not return to play or practice that day and should be cleared by a medical professional before they return at all.

There is no penalty for a school or coach that fails to follow those guidelines. Michael Burnham, assistant executive director for the MPA, said liability is the natural consequence of ignoring the guidelines and keeping a concussed child in play.

“I don’t believe that, because this is a health and safety concern, that there is necessarily a penalty, because we’re dealing with student injury,” Burnham said. “It says right in our guidelines that they’ve got to err on the side of caution.”

The MPA has worked with the Maine Concussion Management Initiative and is considering requiring all coaches to view the 20-minute concussion-in-sport video developed by the National Federation of State High School Associations. The requirement has been approved by two association committees and will be voted on by the full membership in April.

The MPA also requires all coaches to be certified in CPR and to take a first aid class, though they have a year to complete those requirements and are allowed to coach in the meantime. The MPA also requires all cheerleading coaches to be certified by the American Association of Cheerleading Coaches and Administrators, which last year developed its own strict protocols for dealing with children who might have concussions.

However, the cheerleading association has no record of Betsch — one of Olivia’s coaches — being certified.

Duquette, the school district superintendent, said the high school’s athletic director is responsible for ensuring coaches are appropriately certified and he does his job well.

“I don’t know anything about her not being certified,” Duquette said. “I have a hard time believing she wasn’t certified.”

Although Hebert is no longer coaching at the high school, Betsch was hired to coach this past fall.

The Doyer family last year formally notified the school system and the two coaches that they may file a lawsuit, a customary precursor in civil suits. They have not yet pursued that.

Doyer said her intent isn’t to “bash” the school system or its coaches. She just wants more parents, coaches and young athletes to be aware of the dangers of concussions. If her family had, she said, Olivia would have pulled herself out of some of those practices even if the coaches didn’t.

The Doyers are no longer a cheering family. They pulled Olivia’s younger sister from cheerleading after Olivia got hurt.

Last summer, Olivia stripped her room of all her cheering memorabilia. Still, she can’t help missing the sport.

“I loved it,” she said. “I lived and breathed cheering.”

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