Concussions in youth sports: Plenty of risk, not enough education

October 10, 2013

Lindy McDonald is a driven, scrappy point guard, shooting guard and power forward so it's no surprise her first concussion happened on the basketball court.

Playing for her Horizon Christian School seventh-grade team, she went up for a rebound at the same time as an opponent from King's Way Christian. They bumped heads.

One and a half years later, the 14-year-old from Wilsonville is slowly recovering from her third concussion at the same time that such blows to the head, their prevention and treatment are making national news and local impact:

  • In September, the National Football League and more than 4,500 retired players reached a multimillion-dollar settlement related to compensation for concussion injuries and promoting safety for those still playing.
  • In early October, Oregon State University fans got word that running back Storm Woods is out of the lineup until he recovers from a concussion resulting from a kick to the head during the Beavers' Saturday win over University of Utah.
  • Come January 2014, a beefed-up Oregon law goes into effect, requiring youth sports coaches and referees for club and recreational leagues to be trained annually on concussion symptoms, and that players with suspected concussions sit out until they're cleared by a medical professional. Oregon and Washington passed similar laws in 2009 for those involved in high-school sports.

Despite all the publicity, many of those who coach, referee or parent young athletes may not be as educated as they could be on concussions. Same goes for kids and teens.

Providence Health concussion experts want to change that. Collaborating with the Portland Timbers and Portland Thorns, they've developed a detailed, easy-to-read concussion program, packed with fact sheets for athletes, parents and caregivers, a concussion assessment kit, and information on recovering from a mild traumatic brain injury. All of it is available free online.

The assessment kit would be a smart addition to every athletic team's first-aid kit -- or even your home medicine chest.

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Back when your parents, grandparents -- or perhaps you -- were kids, all sorts of lighthearted euphemisms described concussions. Boxers "had their bells rung." Football players got "shaken up on the play" or "saw stars" after a blow to the head.

There's nothing lighthearted about such blows.

Each year, U.S. emergency departments treat an estimated 173,285 sports- and recreation-related traumatic brain injuries, including concussions, among children and adolescents. In the last decade, according to the U.S. Centers for Disease Control and Prevention, such visits for sports- and recreation-related injuries among that age group increased 60 percent.

Dr. Jamie Schlueter, a concussion expert and emergency physician at Providence Portland Medical Center, believes they're "grossly underreported.

"Kids want to play, especially guys," she says. "They don't want to be held out. This is what they love, so they don't tell."

Every concussion, no matter how minor, is a brain injury. Every brain injury is serious. And no one knows what their long-term effect is on young people.

Schlueter signed on to help her colleague Chris Van Wagner, director of rehab services for Providence in Oregon, craft a comprehensive kit to help parents, coaches and kids understand how serious concussions are, know the signs and symptoms, understand what recovery entails and learn how to avoid them.  

Van Wagner saw concussions routinely at Providence Sports Care Center at Jeld-Wen Field. She also worried about them as her son competed in Tualatin Valley Youth Football.

She knew that in youth sports, concussion education for coaches typically is minimal and sideline medical care is scarce or non-existent.  

Frequently, with lots of kids to wrangle, coaches don't spot it when a player takes a bump to the head.

Parents often don't know what to look for.

Helmets are designed to protect against skull fracture, not concussion.

Plus, signs of concussion don't always show up immediately after an injury; they might not be noticeable until days or weeks later.

With all those unknowns, there's an upside. Science and clinical practice surrounding concussion have come a long way in the dozen years since the First International Conference on Concussion in Sport was held in Zurich in 2001. Medical experts there came to a consensus on recognizing and treating concussion and they've since updated recommendations several times.

Education about concussion continues to grow, with help from folks like Van Wagner and her colleagues.

More than anything, they wanted to spread the word that children experiencing any concussion symptoms should be taken out of the game and should stay out until their doctor gives the thumbs-up to return.

Lindy McDonald's mom, Janet, never dreamed her daughter would have the misfortune of suffering three concussions in one short year. And she had no idea how debilitating they'd be for Lindy, who likes to work hard, enjoys school and used to be an athletic bundle of energy.

After the first, in February 2012, she struggled with headaches. Bright light bothered her. She had trouble concentrating.

Following doctor's orders, she slept a lot, skipped TV and limited reading.

A month later, the doctor cleared her for basketball.

That March, playing the same team in a tight-squeeze gym, Lindy was forced into a wall on a fast break.

Her head hit the wall, then the floor.

Dizziness washed over her and a headache came on immediately. She didn't black out but couldn't keep her eyes open.

From the sidelines, Janet McDonald remembers thinking, "This can't be happening again."

The end of the school year proved tough for Lindy. She couldn't focus -- couldn't pay attention to anything for long. Writing and problem solving were difficult and the headaches kept coming.

"It was hard," her mother says, "for her not to put her all into school" as she usually does.

That summer, she rested her body and her brain. By the time school started again that fall, Lindy felt good enough to get back in the game. This February, playing the same school she competed against suffering the first two hits to the head, she took an elbow to the right temple.

It didn't seem serious. She kept playing.

But leaving the gym in the dark that evening, even the glow from streetlights made her cover her eyes. She couldn't stand it. Driving home, she remembers saying to her mom, "Why do I feel so bad right now?"

Janet McDonald's heart sank. "I was thinking, 'It can't be,'" she says. "It was probably just a little bump."

She watched her daughter closely that night and took her to the doctor the next morning. Diagnosis: concussion No. 3.

She bounced back more slowly than the previous times and her family finally took Lindy to Providence Sports Care Center, where she worked with physical, occupational and speech therapists during her slow recovery. Her eyes remained dilated for 4 1/2 months, so Lindy wore dark glasses and kept the lights down at home.

She still had difficulty concentrating in school and is plagued by headaches. Contact sports are out for now, so Lindy's running cross-country.

Her doctor assures her that eventually, she'll recover.

During Lindy's 8th-grade graduation ceremony last spring, her mom says, each pupil in her class was given their own special word describing their character.

Lindy's was perseverance.