The sports considered highest risk, and therefore included under ImPACT, are:
What is a concussion?
The term “concussion” describes a range of traumatic brain injuries that are not visible on computerized axial tomography scans or magnetic resonance imaging tests, said Dr. Ashok Modha, a neurosurgeon at Rebound, an orthopedic and neurosurgery clinic that contracts with Vancouver Public Schools.
Concussions are diagnosed based on symptoms, which can include problems with hearing, vision and memory, Modha said. Other symptoms might include sensitivity to light and noise, trouble concentrating, balance problems, headaches, general confusion and behavioral changes.
A common misconception is that you don’t really have a concussion unless you lose consciousness. That is not the case, Modha said. You don’t even have to hit your head.
The brain floats in cerebrospinal fluid inside the skull. When the body stops abruptly, as it might during a tackle, the head could whip around and cause the brain to hit the inside edges of the skull.
The shock disturbs chemical processes inside the brain’s cells. Rest from physical and mental activity is essential while the brain rebalances its internal chemistry. Symptoms might be worse and might take longer to heal after repeated hits than they do after a single concussion.
High school athletes are more likely to suffer severe effects after second hits than are older athletes, because of the way the brain develops, said Steve Rocereto, an athletic trainer at Rebound.
— Jacques Von Lunen
(Courtesy of the Parsons family )
The lives of Sarah Parsons and Zach Brady once revolved around rebounds, tackles and college applications … until multiple concussions derailed their athletic dreams and nearly kept them out of college.
The Vancouver teens are two examples of a problem that has been getting more attention since three years ago, when Washington became the first state to pass a law on school sports concussions. It's still unclear how many student athletes with long-term effects like Sarah and Zach there are, or how many concussions occur on local school fields and courts. Vancouver Public Schools is the only district in Clark County that for the past year has kept a count of concussions in its extracurricular sports programs.
While more local school districts are now putting programs in place to avoid repeat concussions, much of that prevention depends on players and parents reporting such injuries, even if that means the athlete must sit out a few games. Experts say that locker-room lingo such as "getting your bell rung" undercuts the seriousness of concussions. These traumatic brain injuries can be life-altering and even fatal, especially if teen athletes return to play too soon.
What is a concussion?
A concussion is caused by a bump or jolt to the head — direct or indirect — which changes the brain's internal chemistry, according to information from the Centers for Disease Control and Prevention. All concussions are brain injuries, and all are serious, the CDC says. Especially worrisome are second-impact concussions, or those sustained while recovering from a previous concussion.
The agency estimates that about 60,000 concussions a year occur nationwide in high school sports. That number could be much higher, as an estimated 80 percent of high school sports concussions go unreported, said Elissa Baldwin, an athletic trainer at ProActive Physical Therapy, at a recent coaches conference organized by the Vancouver school district.
Neither the Washington Interscholastic Activities Association, nor the state superintendent's office keep statewide statistics on concussions in school sports.
In the fall of 2011, Vancouver Public Schools introduced a program to prevent repeat concussions in its athletes. As part of this program, the district maintains a list of head injuries in the sports most prone to them: football, cheerleading, soccer, wrestling and basketball. Sixty-one athletes suffered concussions out of about 1,000 who played sports that year, said Mick Hoffman, the district's director of safety and athletics. Thirty-four of the concussions occurred in football, he said.
Avoid repeat impacts
When La Center Superintendent Mark Mansell played high school football in the 1970s, his coaches taught the team's players to lead with their helmets. The coaches required Mansell and his teammates to redo tackling drills if they didn't hear "the crack of the helmet," he recalled.
Mansell ended up quitting football after suffering two concussions — the first while wrestling and the second playing football — and has no lingering symptoms today, he said.
As in Mansell's case, repeat concussions can be avoided by not playing again until all of the symptoms from the initial hit have subsided.
That's what the Legislature set out to do in enacting the 2009 Lystedt Law, named after a 13-year-old boy from suburban King County whose brain swelled after a quick return to a game in which he had already sustained a concussion in 2006. Lystedt couldn't speak for nine months, couldn't stand without help for three years, and still has trouble walking and talking today.
The law requires school districts to educate coaches, players and parents on the dangers of returning to play too soon after sustaining a concussion.
"A youth athlete who is suspected of sustaining a concussion or head injury in a practice or game shall be removed from competition at that time," a portion of the law reads.
Thirty-eight other states have since followed Washington in setting up similar rules.
The Lystedt Law did not prevent Zach or Sarah from suffering debilitating concussions.
Zach suffered numerous concussions on the field during his football career, he said. While playing for Skyview High School, he was knocked out and a week later vomited on the field after a hit. He couldn't sleep. His last concussion came at a summer football camp this past year.
Sarah's concussion story started with one junior varsity basketball game. The Hudson's Bay High School student landed awkwardly on her head while fighting for a rebound. She stayed in the game and suffered several more blows before eventually fouling out. Her coach did not see her hit her head, she recalled.
Life after concussions was as a nightmare for the two former stand-out students.
Sarah stood on stage at the Aug. 8 coaches conference, staring out at the 300 or so coaches hanging on her words. Her smile said everything was OK. Her mother, Victoria, knew better. Her daughter's dreamy, glazed-over stare into the distance said it all.
Sarah prepared for months to share her story: the concussion she suffered, her academic descent from a 3.9 grade point average to individualized learning classes and her ongoing physical struggles. However, on the morning of the symposium, her mother doubted Sarah would be able to take the stage, Victoria recalled. The stress of putting together the speech, the rigors of working this summer and an aversion to large crowds threatened to derail Sarah.
Instead, her presentation captured a piece of, if not all of, the enormous challenges her brain injury caused.
Sarah missed four months of school following her concussion. In hindsight, she probably should have missed more, her mother said, so her brain could have a chance to heal.
Sarah fell behind in class and socially, struggled with depression and had to learn to speak again. Today, her difficulties continue. There still are days when her mother can't allow Sarah to drive a car, she said.
"My brain is like a computer, and it fries frequently," Sarah told the coaches, adding that she could not go to movie theaters, malls or amusement parks, because such activities overstimulate her brain.
Like Sarah, Zach had near-perfect grades through middle and much of high school. But after his last concussion, he shuttled in and out of doctors' offices, forcing him to sit out his senior-year football season and miss substantial amounts of class time. Noise in the hallways overwhelmed his recovering brain. He couldn't focus.
Following a school psychologist's test, the school placed Zach on a student accommodation plan to provide him extra time to finish assignments. He also took classes online.
Zach used to crank out an A-grade essay in an hour, he said. This spring, it took him 10 hours to complete a three-page paper that didn't even pass his own standards. Reading the jumbled reasoning his own brain churned out "was devastating," Zach said.
"I wish I just had a bunch of broken bones, and it could heal," he said.
Luckily, Zach had racked up a lot of extra credits in previous years, because he barely got any as a senior. Zach took summer classes and in August, graduated with the minimum number of credits allowed by the state.
Beyond the law
Hoffman, the Vancouver schools official, choked up on stage after Sarah's speech at the conference, as he recalled meeting with her family in their kitchen. They didn't blame the coach or school district. But their pain and suffering was evident, he said with a hoarse voice. The roomful of burly coaches sat in rapt silence.
Several Clark County school districts have enacted programs that go beyond the Lystedt law.
Shortly after the passage of the law, the Battle Ground Public Schools established its own guidelines on athletes' gradual return to play, said Linda Gellings, director of risk management.
In 2011, Vancouver purchased a program that regulates the return to play in a more formalized way. It is called Immediate Post-Concussion Assessment and Cognitive Testing, or ImPACT. Evergreen Public Schools also will start using ImPACT this school year.
The Camas School District started using ImPACT for spring sports this past school year and will continue using it this fall, said Athletic Director Josh Gibson. The school district will also be keeping a tally of concussions this fall.
Battle Ground will start using ImPACT sometime this school year, Gellings said.
ImPACT tests the function of athletes' brains before the season. That baseline later helps determine how badly a concussed brain was affected and when the athlete can return to practice.
"It tests for symptoms the player can't feel and we can't see," said Steve Rocereto, an athletic trainer at Rebound, an orthopedic and neurosurgery clinic that contracts with the Vancouver school district.
It is important to return to full-throttle activity gradually, said Dr. Marla Kaufman, an associate professor at the Seattle Sports Concussion Program. Even without getting hit, exercising at full speed before the brain is ready might cause concussion symptoms to flare up again, she said.
The head injuries inspired Zach to study sports medicine and physical therapy. He said he wants to help young people who have sustained concussions in school sports.
But first, he has to heal. Zach took the placement test in August at Washington State University Vancouver. The test of basic skills in math, reading and writing was hard for him, he admitted. He'd already been accepted to WSU for this semester, but now has to put that off while he's recovering.
Sarah will give her talk again this fall. This time, it will be a speech videotaped in a studio. The viewers? Student athletes across the Vancouver district.
Sarah is set to graduate next summer, one year after her peers have finished high school. She said she had hoped to attend Utah Valley State and later work for the Federal Bureau of Investigation. She still hopes to go to college in Utah, she added, but her plans now revolve around raising a family.
"She's still not up to what the old Sarah would have approved of," her mother told the coaches. "That's OK. We have a new Sarah, and we love her."