Concussions pose danger for athletes young and old

During a light practice, a Wilson High School football player began showing signs of seizure.

He was rushed to a hospital where he underwent immediate brain surgery.

"We felt he may have had some concussions but had been hiding the symptoms," recalled John "Doc" Moyer, Wilson's head athletic trainer. "He may have been hit on a Friday night and, then Monday, this happened. He had a brain aneurysm."

The frightening ordeal ended the player's football career, though years later he is doing well and living a normal life, Moyer said.

But it remains a reminder of the dangers concussions can pose, especially if left untreated.

When sports are in full swing, Moyer sees one or two athletes per day who exhibit signs of a concussion, though not all are eventually diagnosed with it.

Football players often suffer head injuries, but so do athletes in other sports, such as soccer - where players don't wear head protection, Moyer said.

Concussions aren't necessarily becoming more common in sports, but awareness of them and the long-term health threats they can pose has increased, said Moyer, vice president of the Berks County Scholastic Athletic Trainers Association and a member of the Pennsylvania Interscholastic Athletic Association's sports medicine advisory committee.

Pre-injury testing

Policies regarding the handling of injured athletes have been changed recently at all levels of sports, from Berks youth leagues to the NFL.

And testing athletes' cognitive functions even before a head injury is suffered is becoming standard practice, even in some Berks high schools.

As a volleyball referee, Michael Pursel once saw a female player pulled from a game after suffering a concussion when her head smacked another player's leg while she was diving for a ball.

And as an ice hockey coach, Pursel once told a player to keep his head up and stay alert instead of constantly checking behind him for the puck.

"But he ended up later having collisions and he had two concussions," Pursel said.

The city man has serious concerns about the risks of athletes suffering concussions.

So he is grateful that his son, Jared, 13, has gone through cognitive tests in case the youth suffers a concussion while playing with the Reading Junior Royals.

One or two Junior Royals players suffer a concussion each year, said Michael J. Kondraski, president of the club that is part of the Delaware Valley Hockey League and is an official developmental youth hockey program of the ECHL Reading Royals.

"We take safety very seriously and that's why we wanted to offer this testing," Kondraski said.

The cognitive tests were conducted at the Comprehensive Athletic Treatment Center in Spring Ridge. The center is part of the Reading Hospital Medical Group.

The center has struck a deal with the Junior Royals to provide that and other services in exchange for an advertisement on the team jerseys.

Baseline numbers

Players' cognitive functions were tested to use as a baseline for measurement in case a player is suspected of suffering a concussion, said Dr. Tom Kohl, who specializes in sports medicine at the center and is also a member of the PIAA's sports medicine advisory committee.

About 80 Junior Royals players were tested. Another 40 or so were not because they are at a younger level of play that does not allow checking. The club has boys and girls teams for ages 5 to 19.

The center employs a computer test called ImPACT, or Immediate Post-concussion Assessment and Cognitive Testing.

It tests visual memory, verbal memory and reaction time, Kohl said.

ImPACT works better when performed before an injury so specialists can determine through subsequent testing if a concussion has occurred, said Dr. Cory Keller, who also specializes in sports medicine at the center.

ImPACT is among a battery of tests Moyer uses at Wilson, where for the past decade athletes in all high-impact sports have undergone a standardized assessment before each season. That's a personal evaluation, which Moyer prefers over ImPACT.

Not all schools go to that extent, but it's becoming more common, Moyer said.

"The cliche of a coach asking a player how many fingers he's holding up after he's been hit? You won't see that anymore," Moyer said.

Policy changes

A new policy on concussions has been adopted by the PIAA and the National Federation of State High School Associations.

The new rule requires that any athlete who exhibits symptoms of a concussion be immediately taken out of an athletic contest. Athletes cannot return to the sport until cleared by a doctor, Moyer said.

The National Collegiate Athletic Association has adopted a similar policy.

The issue gained attention after several high-profile athletes recently suffered concussions.

For instance, in 2009, then-Eagles running back Brian Westbrook suffered a severe concussion that sidelined him for weeks. He returned to the field, only to suffer another debilitating concussion.

Since then, the NFL has instituted a policy requiring that an independent neurologist - instead of a team doctor - allow players to return to the gridiron.

Road to recovery

Research shows that once someone has a concussion, the chance of getting another increases by six times, Kohl said.

That might be for a variety of reasons, such as greater susceptibility for some, Kohl said.

He said there's also a psychological factor at play: if a player has recently suffered a concussion, he might be nervous about suffering another.

It can be a self-fulfilling prophecy.

"If a player is constantly looking around to see where he's going to get hit from, he's likely to not be paying attention to other things and he's going to have a problem, possibly another concussion," Kohl said.

Being psychologically ready to return to the sport is one of four factors that Kohl uses to determine if an athlete has recovered.

The other factors include whether there are concussion symptoms while at rest, symptoms while exercising and results of the ImPACT test.

But the ImPACT test isn't foolproof, Keller said.

"Testing does not replace evaluation by a clinician: a trainer or a physician," Keller said. "This is just one piece of the puzzle."

But testing helps because athletes are often so enthusiastic about returning to their sport that they might lie to clinicians or attempt to hide symptoms, Keller said.

Kohl and Keller said that they want youth sports leagues in Berks to become more aware of the risks.

Diagnosing a concussion from the sidelines is a difficult task, Kohl said.

"A lot of times you have moms and dads coaching. They don't have medical training or have very little, and they're called on to determine if something is wrong," Kohl said.

However, picking out odd behavior in someone suffering a concussion can sometimes be easier for parents than coaches because the parents know their child's behavior, said Matt Elston, an athletic trainer at the Spring Ridge center.

And sometimes the diagnosis is a no-brainer.

"If you see a kid go into the wrong huddle, that's easy to pick out," Kohl said.

Contact Jason Brudereck: 610-371-5044 or jbrudereck@readingeagle.com.

(Image by: Reading Eagle: Jeremy Drey)

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