Screenings Give Royal Oak Athletes a Heads Up on Concussions

Royal Oak High School junior Anthony Carter went down hard and was disoriented during a preseason football scrimmage on a hot August day five months ago. But the 16-year-old lineman kept playing and shook it off — or so he thought.

Anthony may not have known what hit him, but his teammates did — thanks to training the players received weeks before the incident that alerted them to signs of a concussion. They informed the coaches and trainer that “something wasn’t right with Anthony,” said the athlete’s mom, Yvonne Carter.

“That’s a lot of football in a lot of heat,” she said. “He faked it, and he played the rest of the game.” 

She credits a concussion awareness program the athletes completed in July with preventing further injury to her son.

is one of the Metro Detroit schools working with to screen athletes, provide a “baseline cognitive assessment” and create awareness of the symptoms of concussions that, according to the American Academy of Pediatrics, account for nearly one in 10 high school athletic injuries.

The program tackles concerns athletes have about brain injuries, such as the danger signs and when it is safe to return to play, and falls right in line with recommendations from the Centers for Disease Control and Prevention, which is asking high school coaches to make concussion awareness part of their pregame checklist.

For Anthony, the prescreening program he and his teammates went through resulted in a call to Anthony’s parents, a trip to the emergency room and diagnosis of a severe concussion.

“The kids observed him acting quiet and confused,” Yvonne Carter said. “They had to tell him where he should be on the field. His balance was off.”

And there were other signs. Off the field, he couldn’t remember where he parked his car, his phone number or his locker combination.

“He got hit toward the end of the scrimmage,” then-Royal Oak football head coach Jeff Hill said. “We were wrapping up, moving kids in and out, and we didn’t get to see him trying to participate (with the concussion). When we got back to the school, a bunch of kids came to us.”

Thanks to his teammates, coaches and trainer, Carter received a phone call, and she and her husband, Royal Oak Police Sgt. Albert Carter, were off to the emergency center at Beaumont Hospital.

It happens all too frequently

Players who follow the news know that sports-related concussions grab the headlines in a variety of sports. Just since the beginning of the year:

• It was one year ago — Jan. 5, 2011 — when Canadian Olympian and National Hockey League superstar Sidney Crosby suffered a concussion from a hit from the Tampa Bay Lightning’s Victor Hedman. One year later the Pittsburgh Penguins hero , prompting some to predict last week that the 24-year-old Crosby’s career may be over.
• The Star Tribune in Minneapolis reported that Jake Deitchler, a 2008 Olympian and University of Minnesota wrestler, announced he was retiring from the sport at age 22 due to lingering effects of multiple concussions.
• Major League Soccer hosted a medical symposium for team doctors and trainers. The league “is looking to take the lead with the best protocols for handling concussions,” Sports Illustrated reported.
• A California Assembly member introduced a bill that would make concussion training mandatory for all California high school coaches.

According to researchers at Ohio State University, an estimated 300,000 sports-related concussions occur each year in the United States, with football and soccer having the highest rates.

A concussion doesn’t just make your head hurt — it actually alters the way your brain functions, said Dr. Neal Alpiner of Beaumont, who treated Anthony Carter in August and for several months following his injury. The effects of a concussion are usually temporary, but they can include problems with headache, concentration, memory, judgment, balance and coordination, the doctor said.

An issue at every age and level

It’s not just an issue with high school and college athletes. Many professional athletes now are finding out they have suffered concussions during their careers.

More than a dozen lawsuits, filed since July on behalf of more than 120 retired players and their wives, say that the National Football League — and, in some cases, helmet manufacturers — deliberately concealed information about the neurological effects of repeated hits to the head, The New York Times reported in December.

“A kid’s brain is a dynamic structure. It’s fragile,” Alpiner said. “If the NFL is taking concussions more serious with adults, then we need to be more careful with kids.”

Concussions usually occur due to a blow to the head, but research also shows that they can happen when an athlete's head and/or upper body is violently shaken. Some concussions cause unconsciousness, but many more do not. Without baseline testing, athletes may not realize they have suffered a concussion.

Alpiner said he sees all kinds of patients with brain injuries in many sports — lacrosse, soccer, hockey and football are at the top of a long list that also includes horseback riding, volleyball, skiing, skateboarding, biking, wrestling, gymnastics and cheerleading.

“I’ve seen concussions associated with nonsport activities,” Alpiner said. “For instance, a kid gets shoved into a locker.”

Concussion screening program pays off

The program at Beaumont was presented last summer by the hospital’s neuroscience team. Athletes playing fall sports were encouraged to use a to help determine a baseline assessment for accuracy, speed/reaction time and memory so, if needed, the results could be used at a future date for a post-injury comparison.

The voluntary program was offered to all student athletes at no charge through Beaumont. Hill said that of the 100 students in the football program, 80-90 players participated.  

Three other high schools — Plymouth High School, Salem High School and Canton High in the Plymouth-Canton Community Schools district — have also participated in the program. To date, 381 students have completed the baseline screening, according to Lori Sheridan, neuroscience administrative manager for Beaumont.

One of the key things Alpiner wants athletes to take away is that an athlete can have a concussion and not lose consciousness. Just like Anthony.

“We want to teach people what to look for," Alpiner said. “We want to change how people look at concussions.” 

He said other school districts are beginning to reach out to him, asking about the screenings. 

A state House bill pending in Lansing (HB 4396) would require all school districts to develop guidelines and provide information about concussion and head injury risks to coaches, players and parents before a student can compete in an athletic activity.

As of October, 31 states have adopted youth concussion laws, according to nflhealthandsafety.com.

Teachers need to know the signs

Concussion awareness forums and screenings make teammates, parents, coaches and trainers more alert to signs, but Alpiner says the team needs to include teachers, too.

“You are only as good as your weakest link,” Alpiner said. He explained that after a concussion, a student may seem to be improving but still could have some issues that could cause grades to come down. He said he writes notes to teachers that say, “No tests or quizzes.”

Alpiner lifts all restrictions on the field and in the classroom when a patient goes for seven days without any symptoms. In Anthony’s case, three weeks after his diagnosis, he resumed conditioning with the team; four weeks after his concussion, he resumed full contact.

“He had to go seven days straight with no symptoms or medication,” Yvonne Carter said. “There was a point when he went for several days symptom-free, and then he got a headache. We had to start counting all over again."

When Anthony finally retook his computerized cognitive assessment test, it came back “unacceptable,” she said.

“That was eye-opening,” she said, because her son appeared to have recovered — but the test showed his cognitive skills were not back to their baseline level.

Carter said she believes a CT scan can only show so much, and she said it was the computerized test that revealed that while her son was on his way to recovery, she did not have her “old Anthony” back yet.

More Than a Game

The Royal Oak football coaching staff members found the concussion awareness program helped them convey the seriousness of the issue to the students.

It’s one thing for players to understand what a concussion is and what the symptoms are, but teaching them why it’s more important to leave — or sit out a game — when they might not feel those symptoms is another. 

“I think that might be the biggest advantage (of the program),” Hill said. “When you get information and stories from multiple people, multiple times, it breaks down that tough-guy attitude.”

Youths don’t want to be perceived by their friends, teammates or fans as being soft.

“These kind of educational pieces teach that one, it’s a game; and two, there’s more important things in your life,” Hill said. “When they start to see all that stuff come together, they understand that being a man isn’t always playing through stuff.”

Carter echoed those sentiments. She saw firsthand how unhappy her son was missing a month of the season.

"It’s hard for a kid to sit on the sidelines while his team wins their first game,” she said, but because of the concussion awareness program, her son was able to acknowledge the risks. "This program was a huge benefit for Anthony."

The football program will continue to be proactive about safety.

Sometimes students will get pulled out a game, even though afterward it turns out they didn’t have a concussion.

“Kids have a hard time with this, but parents understand it,” Hill said. “We have no problem losing a football game by sitting a kid out. If that’s the difference in the game, playing a kid with a concussion, we’ll sit the kid and lose the game all day.”

More on Concussions

• 6 Myths: Young Athletes and Concussions