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A play for safety

Sat., Oct. 3, 2009

Dr.  P.Z. Pearce watches a young athlete take an ImPACT  test at Champions Sports Medicine in Spokane on Thursday. He was being tested after taking a blow to the helmet and not feeling well afterward.  (CHRISTOPHER ANDERSON / The Spokesman-Review)
Dr. P.Z. Pearce watches a young athlete take an ImPACT test at Champions Sports Medicine in Spokane on Thursday. He was being tested after taking a blow to the helmet and not feeling well afterward. (CHRISTOPHER ANDERSON / The Spokesman-Review)

During football practice a few weeks ago C.J. Pier took a helmet-to-helmet hit to the head.

The seventh-grade quarterback and wide receiver at Greenacres Middle School went down. He remembers what happened, including the pain.

“We were doing tackling drills, and I got popped right in the ear-hole by the other kid’s helmet,” he said. “I had a really bad headache after that. Everything seemed a little foggy and lights seemed really bright to me.”

On the ride home after practice C.J. told his dad about the hit and its aftershocks, and they sought help from acquaintance and sports medicine physician Dr. P.Z. Pearce.

The diagnosis of concussion was quick – and disappointing. C.J. missed his team’s first game and many days of practice.

Yet the scenario is growing more common and underscores a new law and serious focus on concussion for organized youth sports in Washington state, whether school-sponsored or private clubs.

Each year across the United States about 75,000 football players in high school and junior high suffer concussions. Another 225,000 student-athletes playing sports such as soccer, basketball, baseball, lacrosse and volleyball suffer concussions.

Most recover and play again. The most important factor is to recognize concussion and ensure that the person doesn’t suffer another one before they recover, doctors say.

Pearce, the team doctor for the Spokane Chiefs hockey team, tells this to young men aspiring to play professionally: “Some of you may make it to the NHL. The rest of you won’t and will need your brains to get by.”

It is rare, experts say, that a student-athlete suffers permanent brain damage from concussions or dies of injuries sustained by a collision.

Valley Christian School football player Andrew Swank died this week after sustaining a head injury when he was blocked and hit the ground. The specific nature of his injuries hasn’t been made public.

Russ Richardson, a regional director of the National Athletic Trainers’ Association, said it is nearly impossible to prevent all such tragedies. But he said Washington’s new Lystedt Law – named after a Maple Valley teen who suffered permanent brain damage after being allowed to continue playing football before recovering from an earlier concussion – is part of a national effort to better prepare coaches, athletic trainers and parents to recognize concussion symptoms and act quickly.

The new Washington law also requires athletes who sustain a concussion to receive the OK from a physician or another certified health care provider to resume play. Without that approval, coaches are not allowed to let the student practice or play in a game.

Butch Walter, activities director at Central Valley High School, said his school follows the guidelines to protect students.

It’s the same at Spokane Public Schools, said Randy Ryan, executive director of the Greater Spokane League. “Staff has always placed student safety first,” he said.

Central Valley is among five regional high schools participating in a new program designed to aid concussion testing among football players and determine when a student suffering the injury is recovered enough to play.

These ImPACT tests, created by the medical staff at the University of Pittsburgh, are being administered locally by Pearce and his staff at Champion Sports Medicine.

Football players from Central Valley, Shadle Park, Gonzaga Prep, Mount Spokane and Lakeside (Nine Mile Falls) high schools took the computer-based cognitive tests to provide Pearce and others baseline data on memory, visual motor skills, brain processing and reaction speed – perhaps the most critical measurement for athletes.

The test includes screen images of X’s and O’s, plus a series of words, designs, colors and shapes.

If a student has suffered a concussion – which the 20-minute test can identify with startling accuracy – then he or she retakes the test later for comparison against the baseline results.

Pearce said it takes at least eight days for an athlete to recover from a concussion. The tests confirm his opinion.

“I’ve seen concussions that I would regard as mild result in taking weeks and weeks to recover,” Pearce said, adding that such a student should not suit up until cleared.

That can be a difficult stand to take with students and parents who are driven to compete, whether it’s for a potential college scholarship or personal success.

Pearce recalled a recent appointment with a father and son that disintegrated into angry shouting.

“In that case the son wasn’t ready yet,” Pearce said. “And the dad, he was like, ‘Well, hell, when I got hit in the head I got up, shook it off and got back in the game.’ ”

Walter said the new law is expected to ease pressure on coaches by parents who want their child to keep competing or to keep a star player in a big game.

“Under the new law a player exhibiting any signs of concussion won’t return to the field. Period,” Walter said. “It’s the law.”

Dr. Edward Reisman, a sports medicine specialist with Family Medicine Spokane, said concussion recognition at games should be relatively smooth.

All coaches and athletic trainers on the sideline are expected to pull players following a blow to the head or a big hit to the body that jars a player’s head. A set of questions testing memory or reactions should give them a quick assessment of brain function. If the player fails, they shouldn’t return to play.

The law is meant to intercept kids with concussions before the next practice or game.

“We want to find the kid who gets his bell rung on Friday night and then his parents notice him staring at his eggs Monday morning,” Pearce said.

He recalled a positive moment during the recent football game between Gonzaga Prep and East Valley High School.

An East Valley player absorbed a big hit near the Gonzaga Prep sideline, then stood and wobbled a bit before returning to the huddle. Pearce said he watched nervously from the Gonzaga Prep side and alerted one of the linesmen officiating the game. At the same time, a referee on the field walked up to the player and said, “Son, you need to sit this one out.”

“That’s perfect,” Pearce said. “He saw the kid get hit and knew what to do. I thought that was really cool.”

Reisman said people younger than 19 are more susceptible to concussions and brain injury. And if their reaction times and judgment are clouded from an earlier concussion, the second, compounding concussion can be very dangerous.

“The consequences could be quite severe,” he said.

Pearce likened concussion to a computer crash.

“When you whack the brain, all the neurons fire at the same time,” he said. “What needs to happen is the brain needs a control-alt-delete.”

While the brain is rebooting, Pearce said, it needs plenty of glucose – a sugar the body produces to fuel the brain.

It’s why Pearce and other experts say rest is the best elixir for someone recovering from concussion. If a person exercises, the body’s muscles steal the oxygen and glucose needed by the brain during this critical time.

Some doctors even suggest students stay home from school while recovering to lessen stress on the brain. “I’m not there yet,” Pearce emphasized.

As the science behind concussions continues to evolve, there’s growing evidence that some people’s brains may be more prone to them than others.

In the days following C.J. Pier’s concussion, he struggled to focus. Normally a good student, he couldn’t do math and reading was difficult. Perhaps most obvious: C.J. said his reaction time was too slow to excel at his favorite PlayStation 3 video games.

“We were really concerned about him,” said his mother, Janet Pier.

After a checkup this week, Pearce gave C.J. the green light to play football again.

“C.J. is a kid with great skills, including a lightning quick reaction time, to go along with smarts that could hold promise for sports success,” Pearce said. “In this case everyone did the right thing.”

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