A long rest after a hard hit

By Rick Ruggles
WORLD-HERALD STAFF WRITER
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DiggNewsvinedel.icio.usRedditFacebookTwitterPRINT EMAIL AdvertisingToughness is treasured in sports.

Players who take serious blows to the head want to get back in the game so badly they'll deny having memory loss or feeling woozy.

Former Husker linebacker Blake Lawrence knows it. He played football from the time he was young, starred in high school in Kansas and started some games for the Huskers in 2008 and 2009.

When Lawrence took another concussion-causing blow to the head during practice last fall, he denied it.

He had promised his family and coaches that he would quit playing if he suffered a fourth concussion. A coach noticed his confused state and asked whether he had, indeed, been hurt again.

“Inside my head, I said, ‘Yes.' Externally, I shook my head and said I was OK,” Lawrence recalled last week.

Scientists gradually are zeroing in on what happens to the brain during a concussion, how long players should sit out and how to assess whether concussion problems are lingering.

Statistics aren't precise because many concussions go unreported, but the Brain Injury Association of America says 1.6 million to 3.8 million concussions occur annually in the United States during sports and recreation. For children and adolescents, the activities that cause the most concussions are bicycling, football, basketball, playground activities and soccer.

The connection between concussions and future debilitation drew more attention last week after a medical journal reported that some people diagnosed as having Lou Gehrig's disease might actually be suffering the effects of repeated concussions. One of them might have been the great Gehrig himself.

Doctors and athletic trainers around the country, including in Nebraska and Iowa, are using computer programs to help assess whether a player with a head injury is recovering.

Still, it's hard to predict how a brain will respond. Some heal quickly from a concussion. Others inexplicably take weeks to recover.

That makes it vital to handle with care those who have suffered concussions, experts in the Midwest and elsewhere say. Trainers, coaches, school nurses and others need to recognize the symptoms and respond accordingly.

“Every case is going to be different,” said Dr. Julie Gilchrist of the federal Centers for Disease Control's Injury Center. “Nothing is a given.”

High school trainers are delighted with a fairly new computerized strategy to measure a player's memory and how rapidly the player can recall words, numbers and shapes.

A Pittsburgh firm developed the computer program, called ImPACT, which is being used by professional, college and high school sports teams around the world.

Many high schools in the Omaha metropolitan area are using it for the first time this fall, thanks to the Nebraska Orthopaedic Hospital Foundation, which pays the $500 required for a school to acquire the program.

Most high schools in Lincoln have used the program for at least two years.

Schools from Crete to Columbus, Neb., are using it, as are the Huskers and Peru State. Iowa schools and teams using ImPACT range from the large, Iowa State University, to the small, Bishop Heelan High School in Sioux City.

Concussion is caused by a jolt to the head that alters the way the brain works. It also can occur in a fall or blow to the body that shakes the head. Symptoms may include memory loss, feeling foggy, headache, irritability, sadness and sleep disturbance.

Scientists have learned that in most cases, concussions aren't evident on CT scans of the brain, because the injury involves cells and microscopic fibers.

A second concussion within days of the first can cause brain swelling, permanent disabilities and death.

Although gains have been made over the past few years in managing concussions, scientists are still learning.

“There's plenty we don't understand,” said Dr. Peter Lennarson, a Nebraska Medical Center neurosurgeon.

Scientists have long known that rest is crucial to recovery, but they now recognize that activities such as studying, playing video games and other activities that require concentration can slow recovery and worsen symptoms.

Tom Frette said that during his 20-year career as an athletic trainer at the University of Nebraska at Omaha he saw many cases in which a player suffered a concussion on Saturday, felt better on Sunday and Monday morning, then felt terrible Monday afternoon.

Going to class and stressing the brain had exacerbated the concussion symptoms, he said.

Frette, now sports medicine coordinator at Nebraska Orthopaedic Hospital, helped create the hospital's foundation, then directed money to provide the ImPACT concussion management program to schools in the Omaha area this year.

“So far it's been great for us,” said Jamee Meysenburg, head athletic trainer at Omaha North High School.

Schools using ImPACT conduct baseline testing of athletes in contact sports. That way, if an athlete suffers a concussion, his post-concussion performance on the ImPACT test can be compared to his baseline score.

Athletes take a 25-minute test on the computer that measures word memory, memory of various designs and shapes, and reaction time. The program provides scores for individual sections and an overall score.

Julie Buck, head athletic trainer at Lincoln Southeast High School, said her school has used ImPACT for five years. It doesn't diagnose a concussion, she said, but it indicates whether symptoms are lingering.

“This is a great tool,” Buck said.

Athletes, she said, don't always tell the truth about their symptoms because they want to play. “They can't lie on the test.”

The test results give trainers, players, parents and coaches solid evidence of how a player is doing after a concussion.

Nineteen athletes suffered concussions at Southeast last year, Buck said.

“We battle this thing with parents — some parents — who say, ‘When I played ....'”

In fact, only a few years ago, most trainers agreed to allow a player back in the game if his symptoms cleared up for 15 minutes, she said.

Sometimes emergency room doctors perform a CT scan on an injured player and inform the parents that nothing is wrong, Buck said.

“Education is the key to everything,” she said.

Most trainers now follow the recommendations that emerged from a November 2008 meeting in Switzerland of experts on sports concussions. They said most concussions cease to trouble the player in seven to 10 days, but the recovery time can be longer, especially in children.

The experts recommended that players who are no longer showing symptoms should test themselves first by walking, then running, then doing noncontact training and finally participating in contact practice.

Each step should be done during a 24-hour interval, so multiple steps shouldn't be done within a single day. If symptoms return, the player must drop back to previous steps.

The days of sending players back in the game after they've suffered a concussion should be over, said Dr. Lori Terryberry-Spohr, brain injury program manager at Madonna Rehabilitation Hospital in Lincoln.

“We do understand that the safest thing to do is to sit them out longer,” she said.

That can be hard for serious competitors to accept, said Dr. Miguel Daccarett, assistant professor of orthopedic surgery at the University of Nebraska Medical Center.

“This is their life, so they will do whatever it takes to come back and play,” he said. “Those guys, they love their sport.”

Blake Lawrence was among them.

Now 21, he is pursing a master's degree in business administration at UNL and created a business to help companies manage their images in Twitter, Facebook and other social media.

Having suffered his fourth concussion within about 18 months at that football practice session last fall, he knew it was time to quit.

That evening, though, he didn't tell anyone he had suffered another concussion. He recalls being quiet and scared in the locker room. He headed out for dinner, walking past the athletic trainer's office.

Then something inside him told him to stop. Lawrence went into the trainer's office and admitted that he had taken another serious blow to the head.

He couldn't risk it anymore.

Contact the writer:

444-1123, rick.ruggles@owh.com

For more information about this article, please visit http://www.omaha.com/article/20100823/NEWS01/708239939

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