Concussions on rise among young athletes
Last Sunday during the game between the Green Bay Packers and the Philadelphia Eagles, viewers saw Eagles' linebacker Stewart Bradley collapse on the field. He had suffered a concussion and already has been ruled out for this weekend's game. In the same game, Eagles quarterback Kevin Kolb had a concussion and will not play Sunday.From the professional ranks down to the peewee level in such contact sports as football and soccer, concussions are much on the minds of medical professionals, coaches, athletic administrators, parents and the athletes themselves.
On Sept. 11, University of Wisconsin-Madison receiver David Gilreath was knocked unconscious and lay motionless in UW's game against San Jose State. Gilreath was taken off the field on a stretcher and did not play on Saturday when the Badgers met Arizona State University.
And earlier this month, Evan Coubal, a sixth-grader from Muskego, suffered a concussion during a youth football game. Days later, he was playing near a football sled when he hit his head on it. He was taken to a hospital, where he died of head trauma.
The three cases are all different, with one ending tragically. But while expert medical care is at the ready at the professional and collegiate levels, there is growing concern and awareness about the impact concussions have on young people. On Thursday, the U.S. House Education and Labor Committee will discuss legislation to reduce and more safely manage concussions in young people.
Nationwide, the tally of concussions is going up because of increasing numbers of young people playing sports, better reporting and a greater awareness of the dangers of a head injury.
This month, the National Federation of State High School Associations estimated that 7.6 million young adults participated in high school sports nationwide, a record. But more kids means more opportunity for injury.
Altogether, anywhere from 1.8 million to 3.6 million athletes of all ages report symptoms of concussion each year, with the majority of concussions occurring among younger people.
Fred Hegeman knows a lot more about concussions than he used to. Two seasons ago, his son, Alex, then a sophomore at Three Lakes High School near Eagle River, was playing right outside linebacker in the last game of the season when he was knocked down by a hard block. Hegeman said his son got right back up.
The opposing team ran the same play again. Alex was knocked down hard again.
"He stayed down this time," said his father.
The coach and trainer went out on the field and spoke to Alex. He was dazed.
He didn't play the rest of the game.
That night, Hegeman said his son had a headache and his pupils were dilated.
"He couldn't remember the play," Hegeman said. "He didn't have any knowledge of the game ending."
Hegeman took his son to a local hospital to be examined.
Months later, Alex suffered another concussion while playing basketball. His father says Alex has had three other concussions since that time, but it might have been worse: Alex also played catcher on his baseball team but moved to third base because of concerns about foul balls clanging off his catcher's mask.
This fall, he is playing football again at Three Lakes. He and the team are wearing better helmets. And Hegeman is watching carefully when his son is on the field.
"One of his dreams was playing college ball," Hegeman said. "He has let go of that dream. He realized this isn't the end of the world."
Is Hegeman worried about his son's long-term health?
"Only from that double hit he received as a sophomore," he said.
Forrest Florsheim, now 17, of Mequon suffered his first concussion at the age of 8 while playing hockey. A month later, he had a second one.
"He said he felt funny, and he began to vomit," said his mother, Jennifer Hamilton Florsheim. "Knowing what we know now, I believe that second concussion made him more susceptible to concussions."
After he had a third concussion involving a trampoline when he was 14, Forrest was told he couldn't play contact sports.
"This was his passion," Florsheim said. "We had to take it away. He has to miss out on that."
At the professional and college level, doctors and medical professionals who have been trained to evaluate concussions are seconds away from a player on the field.
The Wisconsin Interscholastic Athletic Association, the governing body for high school sports in the state, has rules governing concussions. Athletes who display symptoms of concussion or who are unconscious cannot return to practice or competition the same day without a physician's written approval. A doctor also must clear the athlete before he or she can return to competition afterward. And then there is a return-to-play protocol with provisions for gradually getting an athlete ready to participate full time.
The WIAA also has encouraged coaches, trainers, assistants and others to take a free online course offered by the National Federation of State High School Associations that provides more information about concussions.
But WIAA officials and medical experts admit it is unrealistic to assume that a trained medical professional can be at every game at each level.
Physician Kevin Walter, director of the Pediatric and Adolescent Sports Medicine Program at Children's Hospital of Wisconsin in Wauwatosa, sees many of these young patients.
An expert on pediatric concussions, Walter runs the state's only concussion clinic for children and young adults up to age 22. In his practice, he sees plenty of young athletes who have had a concussion but are desperate to get back and play again.
The research, he says, provides evidence that younger children's brains are more susceptible to injury and may take longer to heal.
"Until recently, there wasn't a good place to go for concussions," Walter said. "People would go to the emergency room. We've set up this concussion clinic like a cardiology clinic or a neurology clinic."
The challenge, he says, is that most medicine is evidence-based. "This is common sense and experienced-based medicine," Walter said, adding that making the actual diagnosis is not difficult.
Often, Walter will meet young patients who are not completely honest about their symptoms. They want to play again, and soon.
In one recent case, a 12-year-old patient playing football had a concussion but stayed in the game. He got as far as the fourth quarter.
"He couldn't track fingers," Walter said.
As a doctor who has to rule on whether a young athlete is free to return to play, Walter says he has two rules: A player must be symptom-free and must pass a normal physical exam.
One of the tools Walter and others use is so-called baseline testing. Athletes are given a cognitive test before the season. After the athlete is injured, the test is administered again to see whether any issues pop up.
"Baseline testing is important and can be very helpful," Walter said. "Parents look at the testing and they see them getting the answers wrong and they get scared. Now it becomes real and it sets in."
And while medical experts can't always be available, Walter and the WIAA have been encouraging coaches to learn more about concussion.
"The coaches need to be familiar and aware. Most people are. You have to seek that kid out and ask the questions, get a sense of how they answer," he said.
• Appears dazed or stunned
• Is confused about assignments
• Forgets plays
• Unsure of game, score or opponent
• Moves clumsily
• Answers questions slowly
• Loses consciousness
• Displays behavior or personality change
• Can't recall events prior to or after injury