Shedding light on concussions

"If you want to have a functioning life, you can't play."

Those words were spoken to Tony Sheehan by one of America's foremost experts on brain injuries a week after Sheehan suffered his second concussion in three days playing football.
A quarterback at North Park College after a successful career at Richards, Sheehan had never been shy about returning to action. Like many players, he had become expert at hiding injuries.

"We had JV games as well as varsity games," Sheehan recalled of the 1996 North Park season. "I'd played in the varsity game on Saturday and got a ding running the option. I didn't think anything of it, didn't say anything to anyone. My roommate said my eyes rolled back in my head, and I still didn't go to the trainer.

"Monday, we had a JV game. They sent me in to get experience, and I took a hit. That was it."
This time, he had to be helped off the field. There was no hiding anything. Sheehan was diagnosed with a severe concussion and ordered to rest.
Rest, he did.

"A week later, the symptoms were not going away," Sheehan said. "I was foggy, didn't have my equilibrium."

North Park's staff sent Sheehan to see Dr. James P. Kelly, an authority on brain injuries. Then on the staff at Northwestern University Hospital, he also was the neurologist for the Bears. Kelly's verdict was grim.

"I'd advise you not to play again," Kelly said. " If you want to have a functioning life, you can't play."

While Sheehan's case is extreme, it's not uncommon nor confined to college-age players. Recent studies have found high school players, no matter what the sport, are commonly affected for up to seven days following a concussion.
For three years, the IHSA's Sports Medicine Advisory Committee has been studying concussion management, thus far without recommending to its member schools any particular program for assessing the severity of concussions.

In December, the NFL adopted stricter rules for managing concussions and an NCAA committee recommended a similar rule change. Next season, the National Federation of State High School Associations, whose guidelines are generally followed by the IHSA, will add specific concussion-treatment language to its rule books.

Meanwhile, some area high schools have tackled the issue with technology. Lockport, Argo, Sandburg, Stagg, St. Rita and Thornton are using the ImPACT computer program for analyzing the severity of concussions.

Lockport was the first high school in the state, and among the first few in the country, to use the program when it was introduced in 2000.

"It made a huge difference in how we manage the injury," Lockport head trainer Joe Cunnane said. "I've been a trainer for 20 years. For the first 10, I was crossing my fingers.
"Before, it was, 'How many fingers do you see?' Now, we compare you to you."

Determining the extent of damage after a concussion was, until recently, made by asking an injured player questions and, at times, taking CAT scans.

Then Dr. Mark Lovell, of the University of Pittsburgh, in association with Dr. Michael Collins, created the ImPACT (Immediate Post-Concussion Assessment and Cognitive Testing) system. By measuring athletes' reaction time with a battery of tests on a computer program before a season begins, a performance baseline is made. Post-concussion tests help determine how badly someone has been injured and helps guide treatment.

"I knew immediately this was an objective test in what had been a subjective area," said Collins, who with Lovell has invested more than 15 years in the project. "Left to my own devices as an athlete, I'd say, 'Coach, put me back on the field.' What ImPACT does is show the kid's injured."

Sheehan , now Richards' football head coach, dreamed as a kid of an NFL career. But he accepted the doctor's orders that he stop playing.

"I didn't want to become a vegetable," Sheehan said. "I always loved playing all sports, especially football. I missed the camaraderie of the locker room. It takes you a while to get over it."

Sheehan was a victim of Repetitive Head Injury Syndrome. A sec ond concussion generally takes longer to recover from than a first concussion. If the second concussion occurs before the recovery is complete, the effects can be long lasting.

"I was in a fog for four to six months," Sheehan said.

He was fortunate. In the most severe cases, called Second Impact Syndrome, those with a second concussion before recovering from a first can die.

Even the careful eye of Richards head coach Gary Korhonen didn't prevent some players from hiding concussions. Sheehan did it himself.

"There were a couple of times I was hit, got back up and was calling audibles that we didn't even have," Sheehan remembered. "I've probably gotten 10 to 15 concussions in my life. Some were minor, some not."

Studies in the last decade vividly point out the dangers of multiple concussions. One from 2003 found athletes with multiple concussions were 7.7 times more likely to have memory loss than those who had no previous concussions.

A second study, also from 2003, found those who had suffered a concussion were three times more likely to suffer a subsequent concussion, and that their recovery time was slower after the second concussion. A follow-up study found second concussions are four to six times more likely.

At all times, rest, both mental and physical, is the key to healing.

"There are two don'ts with concussions," Collins said. "No. 1 is don't get hit in the head again. No. 2 is, because the brain cells are starved for energy (after a concussion), if you increase your cognition, it slows down the recovery process.

"High school kids who get concussed and get pushed to get back to school shouldn't be pushed. There's more work in a physics exam than there is in running laps."
The ImPACT program is used by more than 1,600 high schools across the country. Costs start at $500 annually to cover 300 athletes.

Southland schools have been slow to adopt it. Lockport, with Cunnane leading seminars on concussion recognition and management, was in the vanguard. More recent, Argo, Sandburg, St. Rita, Stagg and Thornton have signed up. Several others, including Andrew, Crete-Monee, Lincoln-Way East and Providence Catholic, are considering it.

St. Rita began using ImPACT for baseline testing two years ago with football, and eventually will test all athletes.

"Once we think a player has a concussion, we retest them, but we wait until Monday," St. Rita head trainer Zach Blaszak said. "If we retested on Friday night, immediately after the concussion, the reading would be so low the player would be discouraged. So we won't retest until Monday, and that gives him time to readjust."

It also allows the player mental rest.

"We're trying to limit the amount of stimulus," Blaszak said.

The test, and Blaszak's other observations, determines what happens next.
"If they have a test coming up, I'll talk to their teacher and say, 'He has a concussion. He may not do as well as expected on the test.' We might make him take it again, or delay taking it. So I'll give them a heads up.

"This fall, we probably had five or six players with concussions, and all of them were different," Blaszak said. "One, we had to pull from class for a few days. One had suffered a concussion in lacrosse in the spring, but none of them had two concussions in one season. The lacrosse player, because it was his second concussion, we held him out the mandatory three weeks, even though he had clearance to play from his other doctors."

Some concussions are obvious. A big hit, such as the near-knockout the Blackhawks' Jonathan Toews suffered early in the NHL season, produces a concussion visible from the United Center's top row. But sometimes a small collision can do more damage.

"Sometimes the kid who gets knocked out comes back faster than someone who was not knocked out," Cunnane said. "There are 22 different symptoms. This teaches kids these are all symptoms of concussions. Now, kids will come in the next day, describe something, and say, 'Hey, is this related to the hit I took?' It's one of the unspoken values of the program. It's the collision you don't see that causes the problems."

How quickly a player can return from a brain injury also varies with his age, and that causes frustration at times.

"Sometimes, a parent or coach can't understand why a kid can't come back so quickly," Cunnane said. "Someone at 26 is much different than they are at 17. That can be tough to understand."

The ImPACT system is used in the NFL, NHL and Major League Baseball, along with the Indy Racing League, FIFA (soccer's world governing body) and virtually all major university athletic programs. But some doctors don't get it.

" You still deal with doctors who think a clean CAT scan means you didn't have a concussion," Cunnane said. "A clean CAT scan means you don't have a hematoma, no bleeding."

Collins cautions ImPACT is not the be-all and end-all to determining someone's condition.

"This is a tool, nothing more, nothing less," Collins said. "It's one aspect. It has to be accompanied by an evaluation. You can't just look at an ImPACT report and say someone is ready to return to the field. You have to have a clinical evaluation. The report is part of the evaluation."

Cunnane believes in the system.

"It's the best answer so far," he said. "The injury is so nuanced, with so many things involved. This gives us something to base decisions on before a player returns."

The post-concussion testing is combined with a multiple-step system for determining a player's healing progress. Once a player is symptom-free, he or she can begin light exercise. If symptoms return at any point, it's back to the first step.

If a player progresses through the steps, he or she is cleared to play.

"It's usually between 10 to 14 days, sometimes seven," Cunnane said of his experience with athletes at Lockport.

The decision, a generation ago left to the coaching staff, is up to Lockport's doctors and Cunnane.

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