Delaware health: Young athletes can face a hidden danger

Concussions aren't instantly identifiable
By HIRAN RATNAYAKE

Just after halftime of Indian River's football game with Woodbridge, Tim Bokinsky lined up on offense.

The ball was snapped and the all-conference wide receiver bolted across the line of scrimmage and directly into a "substantially bigger" defender from Woodbridge, hitting him with his helmet.

"I remember hitting him and blacking out, but I never fell to the ground," the 17-year-old junior said. "I know I got really dizzy and had a really bad headache and going behind the huddle and bending over because it was such an awful hit. But I didn't leave the game."
He doesn't remember much else about the Oct. 2 game.

"There was one play where he didn't really even know where he was supposed to be. He was looking around dazed and confused," said teammate Timothy Wood, 17, a senior wide receiver. "Another time during the game, we were getting ready to go out on defense and he looked at me with this glazed look in his eyes and said, 'We're on defense?' "

Wood said he then made sure Bokinsky got off the field. Bokinsky was later diagnosed with a concussion and didn't return to the field for a week.

Had he remained and sustained another bone-jarring hit, Bokinsky could have suffered serious brain damage and possibly died.

The Delaware Interscholastic Athletic Association bars concussed student-athletes from returning to action without medical clearance. The rule is intended to protect them from a dangerous problem known as second impact syndrome, which can kill or disable.
But concussions aren't like other injuries where victims are noticeably hurt and often unable to get off the field -- or even stand up -- on their own. In many cases, a concussion is not easily and immediately identifiable and it can occur without a victim ever losing consciousness. Players also don't have to be in a competition to suffer a concussion. They also occur in practices, out of view of athletic trainers who can't be on the sidelines at every practice for every sport.

"You spend a lot more time practicing than competing so you have more exposure hours [in practice]," said Julie Knowles, vice chair of the DIAA's Sports Medicine committee.
The DIAA requires a certified medical professional, preferably an athletic trainer, to be present at all high school football games.

The DIAA does not require a certified medical professional to be present during competitions for other "collision" sports -- such as soccer, wrestling, boys' lacrosse and ice hockey -- or "contact sports" -- such as baseball, basketball, squash, softball, volleyball, field hockey and girls' lacrosse. DIAA executive director Kevin Charles said those athletes are still being monitored during competitions.

"You invest your resources where you have the highest need, and that's obviously football," he said. "But at virtually every other one of our DIAA events, I always see a certified athletic trainer. I can't remember the last time I was at a contact sport and didn't see one present."
The federal Centers for Disease Control and Prevention says the estimated 100,000 concussions incurred by high school athletes each year are likely lower than the actual figure because so many go unreported.

"There's potential for concussions, especially in basketball, because you're getting bumped a lot," said Aysha King, an 18-year-old center on the girls basketball team and a nursing technology senior at St. Georges Vocational Technical High School. "I feel I have a better understanding just being in the medical field. But I don't think other students fully understand how dangerous they are and that they need to stop playing."

Deadly consequences

When someone suffers a head injury, the brain can slosh around inside the skull, causing blood vessels to tear, brain tissue to bruise and nerves to get injured. A person doesn't need to black out to suffer a concussion.

If a second brain injury occurs before the first one has fully healed -- second-impact syndrome -- the victim can suffer long-term consequences such as dementia, depression and death.
High schoolers are most vulnerable because their brains are still developing, said Mark R. Lovell, a neuropsychologist and the director of the sports medicine concussion program at the University of Pittsburgh Medical Center. They take hits to the head at a speed of 17 to 25 mph, or 98 times the force of gravity.

"A 150-pound kid that runs into a 300-pound player can increase their vulnerability," he said. "If their brain is in a vulnerable state and they get hit again, a catastrophic brain injury can occur and oftentimes they die."

The family of Ryne Dougherty filed a lawsuit recently against Montclair High School in New Jersey after the 16-year-old died after suffering two concussions in successive weeks.
Lawmakers across the country have introduced legislation to improve the awareness and treatment of concussions in youth sports. The Zackery Lystedt Brain Project -- named after a boy who suffered a life-threatening brain injury after returning to football after a concussion -- is promoting concussion-specific laws in scholastic sports. The federal Concussion Treatment and Care Tools Act would commit about $10 million to aid in the prevention, diagnosis and treatment of sports-related concussions in high schools and middle schools.

Delaware is "way ahead of the curve" in requiring medical clearance before a student athlete who suffered a concussion can return to action, said Dr. Michael Axe, an orthopedic surgeon and chair of the DIAA's Sports Medicine committee.

"Ten years ago, only 10 percent of people were aware of how serious concussions were," he said. "Today it's about 75 percent, and that's a sizable improvement."

Desire to play

Part of the issue is that sometimes athletes don't know they've suffered a concussion or don't want to come out of the game.

Wood, captain of the Indian River's football squad, said he's seen other players stay in after a serious head bang because they fear one thing more than an injury: being removed from a game.

"I've seen a lot of people from other teams get hit and I've seen the look in their eyes that shows me that they're out of it," he said. "But they don't want to get off the field."
Wood said he believes he suffered two concussions during the past season. He was kept out of action both times until he recovered. That's not normal among athletes, said Jane Crowley, a psychologist with the Alfred I. duPont Hospital for Children's Division of Rehabilitation Medicine, which runs a project to educate families about brain injuries, specifically concussions.
"It's in their nature to want to continue playing," she said. "But when in doubt, you need to sit them out."
There's still a risk that athletes who suffered concussions in practice never left the action, putting them at risk for further damage. That risk could be greatly reduced if Delaware adopted a rule that required all schools to have a full-time athletic trainer so high school athletes would be better monitored during practices, said Knowles, an athletic trainer and physical therapist.

She said that responsibility should not be completely left to coaches and fellow players. No state in the nation has that kind of rule, and it would require significant funding to take such a step in Delaware.

"There are many, many times when they're not present at practices," Knowles said. "It's not that the schools don't want it. But it would cost schools more money, and [the state] doesn't want to push through an unfunded mandate."

Ready to return?

One action that some schools are taking to get a better handle on concussions is implementing the ImPACT test, which Lovell helped develop. The computerized test is used to determine whether an athlete is ready to return to competition after being concussed. Athletes take the test, which measures visual recognition, memory and reaction speeds, before the season. Those results will be compared to the scores they receive after suffering a concussion. The test is intended to provide insight as to whether the concussed athlete has recovered.
"We can grade how well they're doing compared to the baseline," said Todd Fuhrmann, Indian River's athletic director and head athletic trainer. "I plan on doing it to every athlete I have this summer."

Bokinsky took the ImPACT test. When he suffered his concussion during Indian River's 34-7 victory over Woodbridge last October, his mother, Leah Bokinsky, who was watching from the stands, had no idea how badly he'd been hurt. Only when he returned to his Dagsboro home did she notice a difference.

"After the game, he usually wants to talk about it, but he had no memory of it that evening," she said. "He was just very quiet, and he had a headache and he just laid around a lot. He just seemed disoriented."

Tim Bokinsky said he won't put himself at risk in the future.
"In the past, I definitely would've tried to fake it to keep playing," he said. "But what happened was really scary."

For more information about this article, please visit http://www.delawareonline.com/article/20100219/NEWS03/2190349/Young-athletes-can-face-hidden-danger

Become an ImPACT Client: