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New Research Raises Questions on How to Treat Concussion ‘Epidemic’

November 26, 2007 at 12:00 AM EST
A test that measures cognitive impairment after a concussion is helping coaches and doctors realize that young athletes are sometimes sent back to the playing field too quickly after a head injury. Betty Ann Bowser reports on concussion treatment in student athletes.
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GWEN IFILL: Now, diagnosing and treating high school athletes for concussions. NewsHour correspondent Betty Ann Bowser has our Science Unit report.

BETTY ANN BOWSER, NewsHour Correspondent: The Gateway Gators in western Pennsylvania are having a rough season. Five of the team’s players have been sidelined with concussions, including the goalie, who was hit on this recent Saturday afternoon. Concerned coaches rushed to her side and helped her off the field; it was later determined she had a concussion.

The Centers for Disease Control say the nation is having an epidemic of concussions and that kids are a major part of that, suffering two million injuries each year. Concussion occurs when the brain is shaken violently inside the skull, causing chemical changes that can damage large areas of the brain.

At the beginning of the season, Maura Rodkey was the Gators’ goalie, but for the past two months she’s been on the sidelines with a concussion.

MAURA RODKEY, Student Athlete: Immediately after, I had headaches, nausea, dizziness, fatigue. But as time has passed, it’s just been left with memory problems, like someone will tell me something and I completely won’t remember having that happen, or one morning I couldn’t remember what I ate for breakfast.

BETTY ANN BOWSER: Those are some of the typical symptoms of concussion, but there are other more ominous signs: personality changes, poor grades, insomnia. In some cases, the symptoms can be permanent and in rare cases can lead to death.

Statistically, girls are more likely to get concussions than boys, but researchers don’t know why. Rodkey had two previous concussions. And with each injury, her mom says she returned to play quickly.

MIMI RODKEY, Mother of Student Athlete: Her previous concussions, you know, we held her out until she was asymptomatic, which was about a week or so, and sent her back.

BETTY ANN BOWSER: But groundbreaking research here at the Sports Medicine Center at the University of Pittsburgh has shown it’s bad medicine to send athletes back to play too quickly after a concussion.

MICKEY COLLINS, University of Pittsburgh Medical Center: You can’t manage concussion with a cookbook. The minute I hear a clinician say, “You’ve had a concussion, sit one week out, and you’ll be fine,” is the minute I realize the clinician has no idea what they’re talking about, frankly. And if you try and shove this injury into a little cubbyhole, that’s when you are going to make mistakes.

BETTY ANN BOWSER: After the third concussion, Mimi Rodkey took her daughter to see Mickey Collins. He’s a neuropsychologist who specializes in concussions in kids.

Collins immediately put her through ImPACT, which stands for immediate post-concussion assessment and cognitive testing, a sophisticated computer program that measures function in all four lobes of the brain. It is the first diagnostic tool developed that can map out how a concussion has caused impairment.

MICKEY COLLINS: It looks at one’s ability to remember information. It looks at one’s reaction time. It looks at one’s ability to multitask, to do two things at once. It looks at one’s ability to really maintain attention and concentration.

Maura was at the 2nd percentile for her memory functions. That means that 98 out of 100 girls will do better than her.

BETTY ANN BOWSER: In subsequent testing, Rodkey improved.

MAURA RODKEY: I’m surprised it didn’t give me a headache today. I was happy about that, because I was expecting it to.

MICKEY COLLINS: That’s the first time.

MAURA RODKEY: Yeah.

MICKEY COLLINS: Right? That shows you so much how you’re recovering.

BETTY ANN BOWSER: But she’s still not well enough to return to the playing field. Neither is Samantha Weber, a member of the women’s Olympic development soccer team. She’s been off the field and out of school for two months, after being hit in the head by a soccer ball at a high school game.

SAMANTHA WEBER, Student Athlete: I have like really been tired, and fatigued has been a really big thing. I’ll take naps in the middle of the day. I took a nap today for about an hour.

BETTY ANN BOWSER: Weber started playing soccer when she was 4 years old. Her room is plastered with pictures of female soccer players. Her old shoes and trophies are also on display.

SAMANTHA WEBER: I’ve played seven days a week for the past four-and-a-half, going on five years. So, yes, soccer really is my life. I love it.

MARK LOVELL, University of Pittsburgh Medical Center: Everybody recovers at their own rate.

BETTY ANN BOWSER: When her mom took the talented teenager to see Collins’ partner, neuropsychologist Mark Lovell, Weber was anxious to get back into the game, but her test scores said no.

MARK LOVELL: When people are growing up, it’s crucial that we protect their brains. There’s a lot going on there developmentally, and we want to make sure that we’re promoting a safe return to play standard so these kids are not going back in too soon and re-injuring themselves.

Sam is still recovering from her injury. And, you know, I’m still very optimistic that she’s going to get back to normal. Unfortunately, these injuries can take a good long while to heal.

BETTY ANN BOWSER: Lovell sees the computer program as a crucial diagnostic tool.

MARK LOVELL: Twenty years ago, we essentially had no science with regard to concussion management. In fact, I don’t think it’s exaggerating to say that about 90 percent of what we know about concussion we’ve learned in the last five years.

BETTY ANN BOWSER: Fifteen hundred high schools around the country test their athletes with the program to get a baseline score. The NFL, which has been criticized for sending players with concussions back to play too soon, has adopted Lovell’s program. Most colleges are now starting to use it.

But in spite of its low cost — just a few hundred dollars — it is not in widespread use in either middle or high schools.

David Posluszny was lucky that the Hopewell Township High School he attends uses the test. When the star player had a concussion at a recent Friday night game, he was wearing a helmet, but no helmet currently on the market will fully prevent a concussion.

Athletic trainer Donnie Short knew the 18-year-old was injured. A few days later, Short sent him to Collins.

MICKEY COLLINS: When I saw David, he was reporting to be 100 percent symptom-free. The kid looks normal, OK, looks better than normal. And, you know, are you having a headache? No. Are you dizzy when you stand quickly? No. Are you tired? No. Are you having problems in school with your thinking? No. Are you sensitive to light or noise? No, no. And then we evaluated him on ImPACT, and his data was grossly impaired.

BETTY ANN BOWSER: So Collins sidelined Posluszny for two weeks. When his scores returned to normal, he was allowed to return to the field for the homecoming game.

DAVID POSLUSZNY, Student Athlete: I understand now that if you do push though a concussion, you can still have effects from it 20 years down the road. So it’s not worth it.

BETTY ANN BOWSER: One of the reasons Posluszny was managed correctly was because he had an athletic trainer schooled in how to recognize concussions. The majority of high schools today do not have them.

DONNIE SHORT: There’s a lot of kids going out there that are playing and they can end up running into a serious issues, where it would be a minor hit, and they go down, and they could end up staying down. It could become a life-threatening issue.

BETTY ANN BOWSER: They die?

DONNIE SHORT: Yes, they can die from it.

BETTY ANN BOWSER: Death comes from second-impact syndrome, which can take place if an athlete returns to play too early before the first concussion heals. It only happens to young people, and the numbers are small. Between eight and fifteen are reported each year.

Concern about the syndrome is why Collins sent Westminster College linebacker Eric Miller to an early retirement after his third concussion.

MICKEY COLLINS: What we’re doing is we’re preventing that possibility that he could have chronic long-term symptoms. And I do think we’re reaching a point with him where that’s a possibility. At this point, I want to make it very clear that Eric is going to do fine in life, but his vulnerability for recurrent trauma is too high for my liking.

BETTY ANN BOWSER: Miller still works with the football team as an assistant coach, and he knows he has to be careful to avoid any type of head injury.

ERIC MILLER, Westminster College: I can’t play intramural sports anymore. A simple pick-up game, a bunch of buddies getting together back home and saying, “Hey, let’s go out and throw the ball around, have fun,” it’s something I really can’t do.

Dr. Collins told me that it’s basically like a grieving process, like losing a loved one, something, you know, a game you loved for so long, and you’re unable to play anymore.

BETTY ANN BOWSER: Neuropsychologist Lovell now is trying to take the science of concussions to a new level. He recently completed a study of 200 high school athletes who had concussions. He put them through a functional MRI, where subjects were asked to answer a series of questions while inside the machine. The MRI was used to detect abnormal brain activity. Regular MRIs and CAT scans are unable to detect the severity of concussions.

MARK LOVELL: The lighter shade is greater activation in the frontal areas of the brain. We know that the frontal areas of the brain are involved in various aspects, of memory, decision-making, thinking, personality. And so there’s an increase in cerebral blood flow in these areas, and that’s what we see following even mild concussion. We found that the group who had the highest level of activation in this area took twice as long to recover.

BETTY ANN BOWSER: Lovell and Collins hope their research will one day be able to identify kids who are more susceptible to concussions and direct them to less-threatening, non-contact sports. Meanwhile, the two are doing workshops for doctors, athletic trainers, and coaches around the country, hoping to spread the message of their research.

GWEN IFILL: Again, there’s more on our Web site. Doctors Lovell and Collins will take your questions about concussions in an online forum. Find it at PBS.org.

A new diagnostic tool

Mickey Collins
University of Pittsburgh Medical Center
You can't manage concussion with a cookbook. The minute I hear a clinician say, "You've had a concussion, sit one week out, and you'll be fine," is the minute I realize the clinician has no idea what they're talking about.

Lingering effects of concussion

Mark Lovell
University of Pittsburgh Medical Center
When people are growing up, it's crucial that we protect their brains. There's a lot going on there developmentally, and we want to make sure that...these kids are not going back in too soon and re-injuring themselves.

Testing student athletes

David Poluszny
Student Athlete
I understand now that if you do push though a concussion, you can still have effects from it 20 years down the road. So it's not worth it.

Preventing long-term symptoms

Eric Miller
Westminster College
I can't play intramural sports anymore. A simple pick-up game, a bunch of buddies getting together back home and saying, "Hey, let's go out and throw the ball around, have fun," it's something I really can't do.