The Brain and Behavior Clinic

Your Name: *	Your Phone Number:
Your Email Address: *	Your Address:
- Prefered Method of Contact - Phone Email US Mail
Your Message: *
Enter the code you see above: *

* Required fields are bold

About Sports Concussion Management Program

The Brain and Behavior Clinic is a comprehensive Neuropsychological practice offering expert diagnostic, assessment, treatment, and consultation services to patients across the lifespan. Serving Colorado patients since 1985, the doctors at the Clinic have a strong reputation of providing the highest level of expertise in the assessment and treatment of a broad spectrum of neuropsychological conditions. With an unparalleled group of experienced doctors who have each completed extensive University-based Fellowship training in Clinical Neuropsychology, The Brain and Behavior Clinic offers experience, scientific knowledge, and compassionate care to neuropsychologically impaired patients and their families.

Concussion in sports is common. Approximately 10% of all athletes involved in contact sports suffer a concussion each season. Proper healing and recovery time following a concussion are crucial in preventing further injury. Designed specifically for youth and adult athletes, The Brain and Behavior Clinic's Sports Concussion Management Program emphasizes education about concussions and utilizes two state-of-the-art diagnostic tools which are extremely sensitive to concussive injuries. The SAC is a sensitive sideline assessment tool and ImPACT is a sophisticated computerized program. Both are designed to accurately detect and assess sports related concussions. ImPACT is used extensively by teams in the NFL, NHL, MLB, USOC, and numerous colleges and high schools across the nation. The doctors at the Brain and Behavior Clinic have been granted elite status as authorized instructors and Certified Consultants utilizing the SAC and ImPACT programs.

Currently, all 18 high schools in the Jefferson County School District are enrolled in our Sports Concussion Management Program. We are now in discussions with three other school districts in Colorado and have plans to introduce the program in all of the districts in the state within the next year.

Local Articles:

Deadly game of silence

Concussions, even the seemingly mild ones, can be fatal when they go unreported or unattended over successive occurrences.

By Bill Briggs
Denver Post Staff Writer

On the last run of his life, Adrian Gutierrez carried a football and a secret - he was playing with a concussion headache. Only his best friend knew, and he had been ordered to stay quiet.

After the final football tackle he ever made, Isaiah Martinez uttered these parting words: 'I feel dizzy, I see stars.' His father never had been told about the massive head whack he suffered three months earlier.

And, last weekend, Jacob Snakenberg died after carrying the ball for Grandview High School's freshman team. He had sustained at least two recent hits to his head but never mentioned the accompanying headache to his father.

Three young men. Three early deaths. One common thread: All were killed playing football in Colorado, yet none had been entirely open with parents or coaches about recent blows that left their brains vulnerable to just one more on-field jolt.

'When you're a football player, it's a good thing to be gung-ho, to minimize trivial injuries and get on with the business of winning games. On the other hand, traumatic brain injuries can be deadly - even if the symptoms are minute,' said Dr. John McVicker, the neurosurgeon who operated on Snakenberg this month.

'My guess is this young man was so enthusiastic about football he just wanted to play and he was thinking, 'It's just a headache, it's not a problem.' ... If young athletes hide their symptoms, if coaches aren't aware, they might be playing athletes at their own risk,' McVicker said.

It is the loudest lesson to emerge from the Snakenberg tragedy: Silence is deadly.

In all three football fatalities, the victims collapsed a few seconds after what appeared to be routine collisions. Their brains, at first simply bruised, quickly swelled. In such cases, pressure inside the skull becomes so intense, the heart cannot beat hard enough to pump fresh blood to the brain, McVicker said.

In emergency rooms, it's known as second-impact syndrome. The fatal hit doesn't have to be a bone- crusher but it usually comes before the fatigue, headache or irritability of a previous concussion has faded.

Younger brains, perhaps because they still are growing, are more susceptible to repeated bruising and to second-impact syndrome, experts say.

This is today's school of hard knocks: Each year, 10 percent of all high school athletes suffer a concussion, according to Dr. Stephen Schmitz, a clinical neuropsychologist with the Brain and Behavior Clinic in Denver. Schmitz has more bleak math: Kids with three or more concussions have a 10 times greater risk that No. 4 will be far more serious - a longer period of unconsciousness, a deeper fog of amnesia, or worse.

Before his final game for Monte Vista High School in 1991, Gutierrez confided to his best friend he had a headache from a football hit, possibly sustained two weeks earlier against Trinidad High School.

'You don't tell coach or my mom and dad nothing. I want to play,' Gutierrez, 17, instructed his buddy. That night, on the third play of the second half, the fullback ran the ball to midfield against Alamosa. On the tackle, Gutierrez's helmet bounced off the ground. He got up then crumpled to the grass. Five days later, the team captain and student body president was dead.

'He wanted to play. It cost him his life,' said his father, Lawrence Gutierrez. 'Maybe if Adrian had said something to us ...'Martinez's father asks the same question.

In 2001, Martinez, 21, was playing a pickup football game in a park near Littleton. During a tackle, a friend's heel clipped the back of Martinez's head. He rose, told his buddies he felt dizzy, then fell back to the ground. He died at Swedish Medical Center three days later.

George Martinez later learned his son had been assaulted during a roadside confrontation three months earlier. But Isaiah never mentioned the head injury to his father - possibly because he knew such an admission would keep the 21-year-old from joining his dad in roofing jobs.

'Believe me, if I had seen anything (resembling a concussion), I would not have had him up on the roof with me,' George Martinez said. 'My son respected all the extra work I provided for him. He didn't want to be left out or rock the boat.'

Inside the male and the football culture, some young men simply refuse to complain about injuries or just don't know how badly they are hurt, experts say. At the same time, some prep football players either glorify or minimize concussions, referring to the brain injuries as 'getting dinged' or 'getting my bell rung.'

'I think there is this macho view of a concussion as sort of being a badge of honor,' said Jeanne Dise-Lewis, a clinical psychologist at Children's Hospital. 'Couple that with these kids who have tunnel vision, (who think), 'It's absolutely critically important for me to play because there are going to be reporters there. If I don't, it will be the ruination of my life.' They really do think that way.'

Pat DeBello, the head trainer at Cherry Creek High School, must blend medicine and detective work when it comes to sniffing out players who try and hide head injuries.

When a Cherry Creek player suffers a 'grade one' concussion - some confusion without amnesia or loss of consciousness - they are pulled from the game and quizzed every five minutes to assess their condition.

DeBello begins with the basics: 'What's the score? Who are we playing?' Next, he blurts out three random numbers and asks the player to repeat them in reverse order. Memory is tested as well, with questions about last week's opponent or recent news events. Finally, after a check of the player's pupils and coordination, DeBello orders a quick burst of exercise - a 40-yard sprint, five sit-ups, five push-ups, five knee bends - to ensure the headache or dizziness is gone for good. If the player's head remains fuzzy, he is benched for the night.

'If the symptoms clear up, they are allowed to go back in,' DeBello said. 'We usually give them 15 to 20 minutes, about two series.'

That follows national concussion guidelines drafted by the American Academy of Neurology. After a 'grade two' concussion - when confusion or other symptoms last longer than 15 minutes - the AAN calls for players to stay off the field until their head has been clear for one full week. After a 'grade three' blow - loss of consciousness - the academy suggests players sit for one week if the knockout lasts for 'seconds' and two weeks of it takes 'minutes' to revive the player.

Many Colorado schools, including those in Denver, follow the same criteria. The current AAN recommendations were published in 1997. And in Cherry Creek, where DeBello gives football coaches laminated cards containing the rules, the information is dated 1991.

The science is old. It also may be flawed.

A recent study by the University of Pittsburgh found a hole in that on-field exam that allows clear-headed kids to return to action after 15 minutes.

The Pitt researchers examined 68 kids with 'grade one' concussions. Among those patients whose symptoms had disappeared in five minutes or less, memory and mental sharpness returned to previous levels one week later.

But among the kids who needed six to 15 minutes to clear their heads, neurology tests found they still were not thinking as clearly one week later.

The lesson, Schmitz said: Matching players' concussion symptoms to a one-size-fits-all chart is not the best way to judge when they are ready to return to the game.

'Those (existing guidelines) are not sensitive. You can't use a cookbook,' Schmitz said.

And inside Colorado's largest school district, Jefferson County, that old 'cookbook' of criteria has just been scrapped. This fall, Jeffco prep football players began taking the University of Pittsburgh's ImPACT test - a 20-minute computer exam that measures verbal memory, visual memory, reaction time and processing speed. The goal is to test every Jeffco athlete within two years at a cost of about $900 per school.

Trainers chart each athlete's normal brain function - their 'baseline' ability to think, concentrate, remember and learn. If they suffer a concussion, they are given the ImPACT test again - and are not allowed to play until their brain's abilities return to those original scores. The district relies on Schmitz to help make that call. (More than 200 football and soccer players at Grandview High School also were given the ImPACT test this fall but that is part of an ongoing study - not an evaluation as to when an athlete can return after a concussion).

The new Jeffco system, Schmitz said, should prevent athletes from seeing game action before their brain is fully healed. It also may stem the tide of athletes who suffer a string of concussions before their 21st birthday.

'The tragedy at Grandview is very unusual; we have three to four of those a year who die. The statistics we don't have involve the kids who have two or three concussions and never return to their level of functioning,' Schmitz said. 'They end up not completing college, taking lower-end jobs because they had too many concussions.

'Concussions are cumulative. They build on themselves. And these end up being the guys that just never achieve the potential that they once had.'

Staff writer Bill Briggs can be reached at (303) 820-1720 or bbriggs@denverpost.com.