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Thoughtful treatment

Thu., Jan. 24, 2008

Often, the most serious injury in sports isn’t a high ankle sprain or a torn ACL or a broken arm – it’s a concussion.

Essentially the bruising of the brain, a concussion is unpredictable. One can take out an athlete for as little as a week or as long as the whole season. But more than the intensity of a hit to the head, the seriousness of a concussion can largely depend on an athlete’s head-injury history.

If somebody has had a concussion before – and especially multiple concussions – a lesser hit can trigger another one, and the concussions can get worse and worse, said Washington State University head athletic trainer Bill Drake.

“A lot of times it’s a small hit in the wrong spot or the wrong way, or with a person who’s sensitive to concussions or has had some before,” he said.

Take WSU men’s basketball reserve Stephen Sauls, who is listed as week-to-week after taking an elbow to the head during practice two weeks ago. Though the concussion that hospitalized him for three days may have proved less serious for another athlete, Sauls’ history of migraine headaches complicated his case.

Because a concussion is an injury of the brain, it is a touchier affliction to recognize, to treat and to determine when healed.

“A bruise on the brain, I think, is a fair term,” said Drake, who specializes in concussions. “And that’s obviously different from a muscle. The brain is your electrical center for thinking and all kinds of things. And that’s what makes it such a difficult injury.”

Not all concussions are the same. Some people have symptoms of memory loss and headaches, whereas others can have sleep problems, dizziness and sensitivity to light.

Even using a computer mouse can be a struggle, Drake said, and difficulty learning or staying alert at lectures is a problem at a university. In the long term, multiple concussions can put people at greater risk of dementia and epilepsy.

The short-term symptoms might last for days or weeks or months, perhaps not noticed for some time. A football player might take a big hit in practice and not think something is up for two weeks, after realizing he has had a headache and trouble concentrating since then. If he unknowingly has a concussion and still plays in a game or two, putting himself at risk of more hits to the head, he puts himself in great danger.

“You can take one concussion that you’re not healed from, hit another one, and certainly there are cases of kids dying on second-impact syndrome,” Drake said. “And I don’t want to discount that, but I’ve shifted my pitch. … Death is one thing, but multiple concussions (are going to) really cause everything from headaches and pain and learning problems and shorten a person’s career, because that first one wasn’t managed right.”

So that’s what Drake pushes as assistant athletic director at WSU – correctly managing that first concussion.

To be cleared to compete again, an athlete must pass a series of tests to make sure his or her brain function is back to normal.

“You only have one brain and you only have one chance to really keep that brain healthy and keep it right for your whole life,” Drake said. “And if new science and new literature and data is emerging that, hey, at age 40, 50, 60 you’re (going to) start having earlier troubles based on how we treat your first, second and third concussion at age 20, well, we (want to) make sure to get that right.”

WSU uses a computer test called ImPACT, developed by concussion experts at the University of Pittsburgh. All athletes at WSU take the 30- to 40-minute on-screen exam to determine their personal cognitive baseline, against which their memory, visual skills and coordination are tested again if they suffer a concussion, Drake said.

The ImPACT program is one tool – added to physician appointments and asking if a patient is feeling OK – that WSU uses to determine if an athlete is ready to compete again after suffering a concussion, Drake said.

“It is still a developing science,” he said. “It’s still a bit of an art to evaluate a concussion correctly and do your best to make the right call on that. But it’s getting better, with the neuropsych testing.”

Sauls must pass all the steps before he can step back onto the basketball court. He has watched his team practice several times, dribbling balls in a corner of Friel Court, but he hasn’t been to either of the Cougars’ home games since his concussion.

When he collapsed Jan. 7 at WSU’s Physical Education Building, Sauls momentarily stopped breathing. Trainer Nick Gallotto revived Sauls with one breath of mouth-to-mouth resuscitation, then escorted him to the university’s training facility after a few minutes.

Like most people who get a concussion, Sauls fell unconscious. But loss of consciousness does not equal severity, Drake said.

That Monday night, Sauls was hospitalized mainly to see if he had any skull fractures, Drake said. That’s when his condition worsened, his concussion symptoms becoming more serious. Because of Sauls’ migraine history, blood flow to his brain was low.

Sauls was released Jan. 10 and has since been recovering. His case is considered “complex” – a recovery of weeks – instead of a “simple” concussion, from which a person usually recovers within one week.

“You know, he battled with this his junior year in high school,” WSU men’s basketball coach Tony Bennett said of Sauls. “He’s been better since he got released from the hospital, but (the headaches) haven’t gone clearly away so he can come out here and compete.”

The 6-foot-3 freshman’s future is still up in the air.

Sauls cannot talk to news media until he is cleared, but Bennett said a medical redshirt could be a possibility.

NCAA regulations state that athletes can get a medical hardship waiver if they are injured during the first half of the season and appeared in less than 30 percent of the team’s total competitions. Sauls, who played in eight non-conference games, qualifies.

“If he doesn’t get (medically) cleared and there’s only a couple games left we’ll deal with what’s best for him,” Bennett said.

Sauls hasn’t been the only WSU athlete to deal with a concussion this year. Brynn Bemis, of both women’s soccer and basketball, suffered two – one in each sport – and has since decided to retire from the hardwood, Drake said.

Soccer had one additional concussion and women’s basketball has had three more.

Six WSU football players suffered the injury, including running back Chris Ivory and strong safety Alfonso Jackson. The team averages three to five concussions a season, Drake said.

This year, WSU has seen 13 concussions – up considerably from a whole-year average of eight to 10, Drake said.

“I think injuries sometimes run in cycles and bad luck,” he said.

For football, Drake and WSU are considering putting hit-intensity sensors in helmets that would warn athletic trainers if an athlete were jarred too hard.

The Head Impact Telemetry System in some Riddell helmets is in use by universities such as Oklahoma, North Carolina and Virginia Tech, and WSU is waiting to see if it is a valuable system, Drake said.

“You never take people out of the equation, because we have good physicians and good athletic trainers to speak human to human with a person and evaluate,” said Drake, who is head trainer for the WSU football team.

“We’re always on the lookout for it. We’re always sensitive to it. Obviously, there’s a lot of big hits, so every time there’s a hit you can’t stop and do an evaluation. But you can certainly be aware of it and know the signs to look for.”


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