Athletics trainers in the area will be the first to admit concussions are the most difficult to evaluate and the most critical to do so correctly.

A national study shows 40.5 percent of athletes diagnosed with mild traumatic brain injury (concussions) return to action prematurely and set up themselves for a more serious injury, according to the Center for Injury Research and Policy at Nationwide Children's Hospital in Columbus, Ohio.

"That's very alarming," said orthopedic surgeon Dr. John Speca, who works with Streator Township High School athletics. "I don't want a single one to go back into the game."

That's because Speca is very aware of the dangers of second impact syndrome, a condition that results when athletes return too quickly from a concussion, suffer a second injury to the head and experience severe symptoms that could lead to death. At least 50 players have died nationally from brain injuries since 1997, according to research from the New York Times.

The Center for Disease Control reports 300,000 concussions occur per year as a result of sports participation. Last year, football led the way with 55,007 reported. Girls soccer reported 29,167 and boys soccer reported 20,929. Concussions accounted for 8.9 percent of all injuries to prep athletes in the nine sports studied (football, boys soccer, boys basketball, wrestling, baseball, girls soccer, volleyball, girls basketball and softball).

The most troubling aspect to Speca and athletics trainers in the area is the desire to return quickly. Most of the time athletes rush back due to the increased pressure to win, the naive character of teenagers and the desire to get a scholarship or to live up to a parent's expectation.

"The thing is, (second impact syndrome) is completely preventable,"Speca said. "Iknow parents, athletes and coaches might get upset when you tell them (the athlete) is going to have to sit out their senior season, but the risk is their life."

To an athletics trainer, diagnosis is half the problem.

While area schools have not reported cases of severe second impact syndrome recently, Streator, Ottawa, Marquette, Woodland and Seneca high schools each have a policy in place when it comes to diagnosing concussions and preventing second impact syndrome.

At STHS or Woodland, athletics trainers Brittany Armstrong and Sarah Nourie said they follow ImPACT protocol when an athlete is showing any symptoms of a concussion.

Ottawa head athletics trainer Joe Haywood said his trainers follow the similar Center for Disease Control and Prevention protocol, while Marquette athletics trainer Kristen Wampler and Seneca athletics trainer Christopher Jackson both work for Rezin Orthopedics and follow their own precautionary protocols.

Most protocols include a series of simple questions measuring the athlete's memory before or after a hit. If the athlete fails the test, they are removed from the game and not allowed to return "no matter what." If the athlete passes the test, they must be symptom-free to return to the game.

Still, diagnosing the concussion can be problematic if the athlete tries to hide his or her symptoms, which happens often.

"If it"s an injured body part, it is easy to determine whether or not the athlete returns to the game, but with concussions it"s different," Armstrong said. "No athlete wants to accept that they have a concussion, and most will do their best to hide it from you. That"s where knowing your athletes comes in handy. An athletics trainer really needs to know the mannerisms of every athlete they have on the field."

Each athletics trainer agreed coaches, teammates, parents and the players themselves must be educated on the symptoms of concussions, take those symptoms seriously and alert a trainer or doctor immediately if there is concern.

"Teenagers feel like they are invisible,"Nourie said. "We need to preach and preach and tell them the dangers involved. If we show them something, they can see it. If we show them videos where families talk about losing a child or have an ex-NFL player come in and give their story, I think things like that will help it sink in."

Taking action

Haywood agreed about knowing and observing his athletes and said once a concussion is suspected, firm action must be taken.

Both Streator and Ottawa require an athlete to sit out seven days after a concussion is diagnosed and be asymptomatic before returning to practice or games. A player at Marquette or Seneca must sit out at least three days ("usually more") and then be asymptomatic before returning.

At Woodland, if Armstrong or Nourie are present for the concussion the seven-day policy is enforced. Armstrong and Nourie are trainers for both STHS and WHS and are able to attend most events for both schools. In the event both teams are at home, one goes to the Streator event and the other to Woodland.

"When an athlete is diagnosed with a concussion, they have to give the training staff their helmet (at Ottawa)," Haywood said. "We make the final decision. Coaches have winning on their mind and can get caught up in the moment and send the kid back into the game. They don't mean to, but I've seen it before."

Haywood said keeping a strict policy means staying away from any exerting activity to prevent second impact syndrome.

"I know coaches have asked me, 'well can he at least jog around the track?'" Haywood said. "The answer is 'no.' Even that can trigger a second impact injury."

Armstrong and Nourie said STHS athletics had four concussions this season, while Haywood estimated a concussion per month within their programs.

At schools like Seneca and Marquette, it's impossible for the athletics trainers to be at each team's functions at once. That's why both Wampler and Jackson said they briefed their coaches on what to do.

"A lot of (coaches) have been to the same classes we go to," Jackson said. "I've talked to them about it and told them if they have any suspicion when I'm away to call me and I'll make sure I run over to their practice and check it out."

ImPACT testing

Speca, who serves as a team doctor for the U.S. Olympic ski team, is pushing for STHS and St. Mary's Hospital to implement ImPACT testing to better diagnose concussions. ImPACT requires all athletes in a program to take tests and records each athlete's data, so it can be pulled up on a computer if a concussion is suspected. These tests are geared more toward finding the subtle changes in a players' personality that cannot be tested with traditional questions.

While Streator currently utilizes ImPACT protocol in terms of asking certain questions, it does not have the computer-based system of more extensive questions and testing designed by ImPACT, which comes at a substantial cost.

Haywood said Ottawa used the ImPACT system for two years in the past and believes it can be overwhelming to keep up with testing, suspecting it is still easy for players to "cheat'on those tests to stay in the game.

Wampler, who attended concussion seminars, said she would like to see Marquette implement the ImPACT system but knows it is not financially feasible for a school of its size.

"Instead, Ihave to keep a close eye on my athletes," Wampler said. "If they for sure have a concussion, they sit out. If they have a minor headache, I lecture them sternly that if they start to feel any symptoms or it gets any worse what can happen and they have to tell me right away."

The iffyness for an athletics trainer involves situations where an athlete reports just a "headache."Speca admits headaches can occur without being traumatic brain injuries. At STHS, the policy for athletes suspected to have "just a headache" is to sit out at least 24 hours without symptoms, then pass the ImPACT protocol to return.

Speca believes the ImPACT system can better help athletics trainers make those hard decisions between "what's just a headache?" and "what is a concussion?"

He emphasized under no circumstances should a trainer supply ibuprofen or aspirin to a player because of the potential complications those medications can cause with concussions.

While not everybody agrees on which policies are best to prevent second impact syndrome, each school expressed safety as its No. 1 concern.

"There's just too much to lose over a game,"Speca said. "I hope everyone keeps perspective and the adults around these athletes continue to take every precaution. It's just better to have missed a game or two than to end up dead."






Signs Observed by Staff:
Appears to be dazed or stunned
Is confused about assignment
Forgets Plays
Is unsure of game, score, opponent
Moves clumsily
Answers questions slowly
Loses consciousness (even briefly)
Shows behavior changes
Forgets events prior to hit (retrograde)
Forgets events after hit (anterograde)

Symptoms reported by Athlete:
Headache or pressure in head, nausea, balance problems, dizziness, double or fuzzy vision, sensitivity to light or noise, feeling sluggish, change in sleep patterns, concentration and memory problems.

Athletes symptoms can actually increase with exertion and no athlete should return to play until symptom free.

Source: The Center for Disease Control and Prevention

ImPACT Protocol On-field Cognitive Testing
Ask the athlete the following questions
-What stadium is this?
-What city are we in?
-Who is the opposing team?
-What month is it?
-What day is it?

Ask the athlete to repeat the following words to test for anterograde amnesia.
girl, dog, green

Ask the following questions to test for retrograde amnesia
-What happened in the prior quarter/period?
-What do you remember prior to the hit?
-What was the score of the game prior to the hit?
-Do you remember the hit?

For concentration ask the athlete to do the following.
-Repeat the days of the week backward? (starting with today)

-Repeat these numbers backward
63 (36) 419 (914)

Word List Memory
Ask the athlete to repeat the 3 words from earlier
-girl, dog, green