June 18, 2018
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Schools tackle head injuries suffered by student athletes

BDN photo illustration by Nick Sambides Jr. | BDN
BDN photo illustration by Nick Sambides Jr. | BDN
High schools statewide are complying with a new state law and employing special tests that monitor student-athletes before and after head injuries occur.
By Nick Sambides Jr., BDN Staff

LINCOLN, Maine — Morgan Russell thinks she has suffered two concussions, but she’s not sure.

The first came earlier in her high school career when the 18-year-old Lincoln senior was dribbling upcourt during a Mattanawcook Academy girls basketball game. An opposing player accidentally head-butted Russell when she went for the ball, Russell said.

“It was just right on the temple — really impacted it,” Russell said Thursday, “and then I had headaches for a couple of days. I still practiced. I didn’t think anything of it.”

Then, during another game, Russell started losing her vision. Alarmed, her coach immediately benched her until the headaches went away and her eyesight returned to normal, she said.

“It was really scary. I had never suffered a concussion before. I wasn’t really sure what to do,” Russell said.

The next concussion might have come when Russell was playing softball. Her helmet flew off during a slide into a base. Something — the ball, a knee? — hit her. Seeing signs of concussion, her coaches took her out of the game.

“I wasn’t really sure. It happened really fast,” Russell said.

The next time Russell gets hit in the head, she, her coaches and family won’t have any doubt whether the three-sport athlete has a concussion. Nor will she play in a game or practice until tests show that her brain has completely recovered from the trauma, said Rick Meyers, the academy’s athletic director and assistant principal.

The Lincoln high school has partnered with Penobscot Valley Hospital of Lincoln and enrolled in the Maine Concussion Management Initiative, a program created by Dr. William Heinz, a Portland orthopedist, and Dr. Paul Berkner, director of health services at Colby College in Waterville.

Over the last month, about 160 student-athletes at Mattanawcook Academy have taken ImPACT — Immediate Post-Concussion Assessment and Cognitive Testing — a computerized neurocognitive testing program that has become a standard tool used in comprehensive clinical management of concussions for athletes of all ages. The entire school population might be next, Meyers said.

The test acts as a baseline measurement of memory and reaction time. If a student suffers a head injury, the results of the initial test will be compared to follow-up exams to measure the extent of brain-function loss caused by the injury. The tests also will measure how much brain function is recovered, said Dr. Carl Alessi, a family physician at Penobscot Valley Hospital who helps oversee the program.

When the post-injury test results match the baseline exam’s, the student will be allowed to resume athletics. The program represents a dramatic change in how brain injuries are regarded, Alessi said.

“In the past, when you had a head injury, it was, ‘Do you know where you are? OK, go back into the game,’” Alessi said. “You had your bell rung, you were a little bit groggy, but if you knew where you were, you’d go back in to play, often times with some very serious consequences. A lot of times, these head injuries are not recognized as such.

“Yeah, when someone gets knocked out, that’s easy, but the kid who gets a little bit dazed because he gets his bell rung may walk straight, he may talk OK, but he may not be able to do his calculus problems that day,” he added. “He may not be able to read Shakespeare, he may not be able to run his down-and-out pattern like he should. He may not be able to protect himself from being hit again, and that’s the danger.”

The discovery in recent years of the high incidence of long-term head injuries suffered by National Football League players — with the injuries’ ill effects surfacing sometimes decades after players ended their careers — helped spur the creation of the concussion-management program.

A study published in a recent issue of the medical journal Neurology surveyed nearly 3,500 retired NFL players who were in the league between 1959 and 1988 and found that the players are three times more likely to have neurodegenerative conditions, such as Alzheimer’s disease, than the general population. The study found four times the risk of amyotrophic lateral sclerosis, also known as Lou Gehrig’s disease.

According to the study, the average age of the 334 pro footballers who had died was 57. Seven had died from Alzheimer’s and another seven from ALS. Three players had died with Parkinson’s disease, but that number was not significantly higher than the general population.

The study also found that 62 percent of the players surveyed who had evinced signs of late-stage fallout from brain injuries were in speed positions — quarterback, running back, linebacker — compared to positions on the offensive and defensive lines. This indicated that high-speed collisions caused the most damage.

But brain injuries can occur with most any athletic activity, at any level, Alessi said.

“It’s not just football. It’s all sports,” he said. “You see head injuries in soccer, field hockey, lacrosse, volleyball, wrestling, even cross country [ and cheerleading]. People fall. People whack their heads when they fall. Golf, skiing … there are lots of sports where people get their head injured. Often [severe head injuries] are not discovered because they are not high-velocity injuries.”

As part of the concussion management program, Meyers said, parents will be notified of a head injury suffered by their children during athletics and will be encouraged to take them to doctors. Meyers pressed for the school’s involvement in the program this fall after recently becoming MA’s athletic director and discovering that his predecessor had begun to implement it.

Meyers said the school is probably a latecomer to the program, which was created about five years ago. A new state law signed by Gov. Paul LePage in May requires all high schools to adopt and implement policies on management of concussive and other head injuries in school sports, practices and other activities over the next year.

The policies require all schools to remove from practices and games any student suspected of having suffered a head injury until there is written clearance from a licensed neurologist or athletic trainer stating that the student is free of symptoms of a head injury. The policy acknowledges the potential to cause more harm if athletes with head injuries aren’t benched immediately. Maine joined at least 30 states in creating anti-concussion laws.

According to the federal Centers for Disease Control and Prevention, emergency room visits by children and adolescents for concussions increased by 60 percent in the past decade. Each year, emergency departments treat more than 173,000 sports- and recreation-related traumatic brain injuries.

Russell said she is glad her school is participating in the program. Though her injuries occurred years ago, she still suffers, she said, from headaches and has some slight short-term memory difficulties.

“It’s a constant, being afraid of being hit in the head again and not being able to play sports anymore because of suffering from too many concussions,” Russell said. “I don’t really think anybody my age really understands the seriousness of them, or how damaging it can be if you don’t take special care of it. … We are not really informed about them a lot.”

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