Concussion world?


While I admit to not being the absolutely most attentive soccer mom, I do usually at least notice when my child is whacked about during the game.

But this past week, our oldest, the high school freshman, came out of the game with blood above his eye. This surprised both my husband and I, and our daughter, as none of us had seen any reason for this. Worse, when we questioned him, he said that he was not very concerned about the bleeding-he felt funny from the other hit he had taken before that. He even wondered, "Could it be a concussion?"

Once at home, together, he and I looked up the symptoms of a concussion online. While I thought perhaps his pupils were dilated, nothing else matched particularly. He was tired, but not nauseous or dizzy. I had hauled his brother to the ER at BMH a couple of years earlier, the result of some game he called "spinney-spinney-me-go-round," of course played only on the paved portion of the playground, so that he whacked his noggin quite effectively when he fell (repeatedly). During that night, he had gone through various moments of being incredibly active (normal) to curling up into the fetal position on the couch ... eating and then refusing to eat ... and then topping it all off with telling me, while listening to me read a book, that it was really "funny" that the world would "just go white every once in a while." (The last comment sent me racing to the ER.)

So, in light of nothing like these other symptoms his brother's concussion had shown us, we sent him off to bed. The next morning he got up earlier to complete homework. He mentioned that he would stop to see the "trainer" at BUHS, and just to make sure, as his head was a little sore. I sent him off, glad to hear that there was someone at school that would look at it, but figuring that it was on the side of the infamous "abundance of caution."

So, I was shocked (and felt rather like a bad mother) when he came home that night to say that the head athletic trainer, Josh Underwood, had determined that he was indeed "concussed," and that he was not going to be able to play in the soccer games for "a while" -- and even that he was likely going to stay out of band for a few days since it hurt his head.

When Josh called to follow up with me as the parent the next morning, I was ready with a few parent-like questions. But as I talked to him more, I became very intrigued and started to interview him for this column. I had already been impressed-as a mom-that the school made each child undergo some "baseline testing" before they started the fall sports play. I chalked it up to the great caution we must practice today, but didn't really figure that my own child would need it. After all, I am the reason he does not get to play football: I have read too many studies about the head injuries, and just can't stomach the idea of my child's precious brain becoming mottled because of a sport. "Play soccer instead," has been my rallying cry ... and honestly, I have actually encouraged all my kids to avoid heading the ball. (Sorry, coaches.) It's just not safe, again, from what I have read.

Turns out that I was right ... and wrong. The heading of the ball is definitely a problem. But according to Underwood, it's not football that causes concussions in the majority of the kids at BUHS. Want to guess what the sport is? I was surprised: girls' soccer. Followed by girls' hockey. Then football. And then back to girls' -- lacrosse. (And yes, our three kids are all playing lacrosse -- and loving it -- as we parents are, watching a very unique, fast-paced, fun game.)

Josh explained that there are about 250-300 kids playing sports at the high school level each year. Every year, he sees about 30-35 concussions. The first question I had for him was: "Why girls?"

Josh said that there are a lot of different theories. "I have looked at the studies about at head gear for women playing soccer, and studying the effectiveness of their equipment," he says. "They found that there is no difference in the amount of force that a male or female puts on a head butted soccer ball ... but there was a difference in the neck musculature, which can slow their head in the women. Women are following through with much more force."

This coming into contact with another object -- with force -- causes the concussions, he explained. I had understood the concussion to really be the act of the head banging about on the skull-which sounds nasty enough to me, actually. He agreed, but said that his doctoral is looking at a couple of things. "When you have a concussion, there is dysfunction in both the neck and the musculature. It's not just the brain rattling, although the general thinking is that the brain is generally hurt.

"But we also think that the neck and the muscles surrounding the head act as a tuning fork. The pain and vibrations hit the area, and that makes the pain that much worse," he said. Josh is working on a doctoral dissertation currently, and it is on the use of manual therapy in reducing symptoms reported by patients with concussions.

"Our theory is that the concussion causes some sort of dysfunction in the neck and surrounding musculature that increases some of the symptoms reported by patients," he said. "Alleviating the pains on the outside of the head actually make the concussion symptoms feel better. In fact, a couple of colleagues of mine have found that one treatment can reduce symptoms 70-75 percent."

Josh noted that the data is in the very early stages of the research process-and could definitely change. His colleagues are from a Division 1 football programs, a Division 2 solid athletic program, and a junior college in San Diego, where most athletes go onto play for Division 1 programs. "This gives us a very good spectrum of patients in trying to prove our theory," he said.

While this sounded good -- who wants someone else to be in pain? -- I was concerned that this would mean that this meant my son would feel well, and go back to playing before his brain was truly completely healed. Josh assured me that this is why they have the testing.

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"There are three levels of clearance before they start to come back into play-and they come back slowly, not all at once," he reassured me. "There are also two or three methods of determining if someone has a concussion."

"To determine if someone has a concussion, we apply SCAT3 assessments, the ImPact testing system, and my own experience. I've had probably close to 400 patients with concussions, and managed each of them as they healed from their injuries," he noted.

"To determine if -- or when -- they get back to the sports, they need to pass essentially three levels," he detailed out for me. "The first is "passing" the SCAT3 testing. The next step is having their ImPact scores returning to within "normal" ranges on the test. The last section is a slow, gradual increase of exercise, based off of their heart rate. It is a five-step program, starting with very light exercise and progressing to more advanced exercise or non-contact practices.

"If they go through the return to play protocol with no problems, they are allowed to return to athletics. Only about 10 percent of the time someone has symptoms return with activity, but that is why we have the return-to-play process."

The whole testing that Josh had done seemed much more intensive than what we had at the ER, quite honestly. The ER doctor held up fingers, and asked questions about what the game caused him to do, how many times he had fallen, where he had hit his head. The doctor diagnosed the concussion based on the "isn't it funny how the world just whites out" comments mostly. There was no real, definitive test.

Fast forward about four years, and we are apparently in a whole new game in the concussion world. These cognitive tests that were done as baselines were key for our oldest. The results came back with a drop off down to only 60-80 percent of what he had done just a few weeks earlier.

Josh explained more about the tests. "They have a word memory section, and a picture memory section. They memorize certain designs. Then there are reaction tests, hitting different keys for colors or designs. Then they have to count backwards from 25 to 1 as fast as they can; then they have to type in the three letters." He concluded, "After all that, the last two sections are to recall the words and the designs from the beginning of the tests. It's pretty much testing every section of the brain and its functions, to make sure it is not damaged." He also said that there were samples of the testing online, if anyone was interested in seeing them, at

By the way, Josh is not satisfied in just trying to treat concussions: he wants to find ways to stop them. To do that, he is currently involved with a research study out of Idaho State University (which our son is now a part of, too).

But more quickly, he is making an impact here at BUHS with his own and purchase of impact-reducing head bands. He also includes pre-season conditioning, ACL prevention conditioning and strength training to decrease injury trends.

"We had way too many concussions on the varsity girls' soccer team two years ago -- eight or nine in one season," he said. "So I purchased some impact-reducing head bands that I had seen in research. We made it mandatory for the varsity team. That next year, we had no concussions-not a single one. That's an impressive thing."

Unfortunately, his budget got drastically reduced this year, and he didn't have the ability to buy more. There are newer, more scientifically studied ones he has also found, which would should be even better-but are more costly. Football helmets are also getting better, and some football students actually buy their own helmets instead of using those provided by the school. Lacrosse gear, too-especially for women-is just not adequate, he said. "There needs to be more protection for the errant ball or stick. There just needs to be improvement in head protection for women's lacrosse."

In any case, Josh promised to keep our family updated on the recovery of our sons' concussion. He'll test him every day, to see when his cognitive functioning is back to where it was before the soccer squabble that we parents couldn't even see.

Good to know, isn't it, that our schools are caring for the safety of children on such a level?

Jill Stahl Tyler is a parent to three children involved in the local schools-now at the high school, middle school and elementary school levels! She firmly believes in all education, and currently sits on the board for the Brattleboro School Endowment, the Brattleboro Town School Board and the Early Education Services policy council.


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