CONCUSSION CONFUSION.

Byline: YOUTH SPORTS INJURY By Tim Christie The Register-Guard

Like so many athletes, Meredith Laing doesn't remember the blow that knocked her silly.

It happened Dec. 4 during a basketball game: Another player's elbow or head collided with Laing's face, causing her brain to move violently inside her skull and disrupting her brain function. Four months later, Laing is still not well.

"My head hurts constantly, all the time," said Laing, a 14-year-old freshman at Marist High School.

All she can do now is wait.

Laing is among the 700 to 800 high school athletes who suffer concussions each year in Oregon - a conservative estimate, experts say. Nationally, about 300,000 concussions occur each year among young athletes.

Head injuries have always been a part of competitive sports, the inevitable result of bodies flying around a court or a field, of skulls colliding with other skulls, limbs or the ground. While such injuries may not be preventable, doctors, coaches and trainers are doing more to recognize concussions and make sure athletes are fully recovered before resuming play.

"Early recognition and proper management are the keys," said Dr. Mick Koester, a Eugene pediatrician who specializes in sports medicine.

Koester is leading an effort in Oregon to raise awareness about concussions and to educate coaches, parents and others on how to recognize concussions and how to help athletes recover from such brain injuries. He's established the Oregon Concussion Awareness and Management Program, which would provide seminars for coaches, educators, parents, athletic directors and trainers in every corner of the state.

"People at a game or practice need to recognize concussion," he said. "They need to take the kid out of the game or practice and get them evaluated by a physician."

The only treatment for concussion is rest, both physical and mental, he said. Koester recommends keeping athletes with concussions at home for at least a few days, where they should avoid reading, watching television or engaging in any activity that requires them to think.

Nationally, football has the single highest rate of concussions among high school sports but together, boys and girls who play soccer are most likely to suffer a head injury, according to a 2007 study in the Journal of Athletic Training.

Girls are 60 percent more likely than boys to suffer head injuries playing soccer, and girl basketball players have a concussion rate three times higher than that of boy basketball players, the study found.

It's not clear why girls are more susceptible to concussion, Koester said. They may not have as much body control as boys, which may cause them to play rougher, he said. They also don't have as much muscle mass in their necks, he said.

It looked like a seizure

A concussion is a brain injury caused by a bump or blow to the head that causes the brain to move rapidly inside the skull and disrupts the way the brain works. Contrary to a common misconception, an athlete doesn't have to be knocked unconscious to suffer a concussion.

When a young athlete takes a hit to the head, what happens next can be hard to watch, as anyone who was in the stands at the Thurston-North Eugene basketball game on Feb. 15 could attest.

Jonny Wymore, a burly 6-foot-1, 215-pound Thurston senior, was guarding North Eugene's Brian Conklin when the 6-foot-8 Conklin took a pass at the top of the key. Conklin swung his elbows as he turned to face the basket, catching Wymore flush in the face. The blow broke Wymore's nose and knocked him to the floor, where he remained for several agonizing minutes, woozy as a prizefighter in the 12th round.

"He didn't know where he was," said his coach, Doug Piquette. "The only thing he knew was his name. They said he was out, but his eyes were open. It looked like he was having a seizure."

Wymore said he remembers coming to briefly while on the floor, hearing crowd noise and seeing faces looking down on him. His vision was blurry, "like when you look through water," he said. He remembers sitting on the bench, crying and asking to be put back in the game. He remembers the trip to Sacred Heart Medical Center, asking over and over, "What happened?" He remembers his head throbbing in pain.

"I was so out of it," he said.

His headache and clouded vision continued for at least a week. He stayed home from school for a few days and slept a lot, but it was poor sleep, he said. After about a week, as his symptoms subsided, he resumed light jogging. His doctor cleared him to play in time for the state playoffs March 7, three weeks after his concussion. He played the following week in the state tournament, where Thurston took third place, its highest finish ever.

Wymore said he felt completely recovered from his injury. Thinking back, though, he said, the concussion "scared the heck out of me."

Computer test makes an ImPACT

A concussion can't be detected by an MRI or CT scan, which can make it difficult for doctors, coaches and parents to determine when an athlete is fully recovered. That's why one of the tools gaining wide use among high school, college and professional sports teams is a computer-based program called ImPACT.

Developed at the University of Pittsburgh Medical Center, the ImPACT test measures an athlete's cognitive and neurological function. Ideally, the test is administered before the start of the season, to provide a baseline score when the brain is functioning correctly.

Then, if an athlete suffers a concussion during the season, he or she can take the test again and the post-concussion score can be measured against the baseline score to gauge how well the athlete is recovering.

The test, which takes about 20 minutes to complete, features six different modules that measure different areas of mental function in athletes such as attention span, working memory, problem-solving and reaction time. For instance, an athlete is briefly shown a list of 12 words, then is asked to pick those 12 words from a list of 24 words.

The ImPACT test is used, to varying degrees, by local school districts. Willamette High School in the Bethel School District in Eugene has been using the test for about four years and while ImPACT is not officially mandated, it is strongly encouraged, said Ricky Rodriguez, Willamette's athletic trainer. A parental consent form for the ImPACT test is included in the athlete's packet and probably 95 to 98 percent of athletes take the test, he said.

"It's worked really well for us," said Barry Bokn, Willamette's athletic director. "Our coaches bought into it and feel comfortable with it."

The test takes some of the guesswork out of determining whether an athlete has recovered from a concussion, Bokn said. It takes pressure off coaches having to decide whether a player is ready, and it helps convince gung-ho athletes that they need more time to let their brains rest, he said.

Not widely used in Eugene

ImPACT also is used in Eugene School District high schools, but to a lesser extent.

"I honestly couldn't tell you how many kids use it," said Tim Carmichael, the district's activities and athletics coordinator, and athletic director at Churchill High School.

Laura Baker, athletic trainer at Sheldon High School, said maybe 20 percent of Sheldon athletes take the baseline ImPACT test. "Unfortunately, we've been unsuccessful in requiring athletes to take it," she said. "Part of it is, parents are skeptical."

South Eugene High School trainer Marlee Hansen said she, too, has not been able to get many parents to return the parental consent forms for ImPACT tests. She hopes to work this spring to test more athletes competing in fall sports.

"I've got to get on my football coach to get forms home and get those kids tested now," she said.

At North Eugene High School, trainer Cesar Ocampo said he's been able to get about 95 percent of the athletes playing football, soccer and basketball to take baseline tests. It helps that the coaching staff supports the program, he said.

He notes that his job is easier because North Eugene has far fewer football players - between 50 and 60 in all four grades - than a program such as Sheldon, which fields four full teams.

Carmichael said ImPACT is not more widely used in Eugene high schools in part because some parents see it as intelligence testing and worry about how the information will be used.

Springfield High School began using ImPACT this year, testing upper-class athletes who play high-impact sports, Athletic Director Matt Binkerd said. He said he plans to talk to trainers about whether to broaden its use next year.

ImPACT is not being used at Thurston High School, Athletic Director Mike Michel said.

"I don't have enough information to make a valid decision," he said.

This isn't the boogeyman

Dr. Micky Collins co-developed ImPACT at the University of Pittsburgh Medical Center, where he serves as assistant director of the Sports Medicine Concussion Center. He said ImPACT is not an IQ test, and it complies with federal law protecting patients' medical information.

"This isn't the boogeyman," he said.

Rather, it's a tool that helps provide answers to an "elusive injury." The only way to evaluate how someone is recovering from a concussion "is to put the brain to work," he said. "It's the only objective way to measure the injury."

ImPACT can be used to gauge recovery from a concussion without the baseline testing because test scores can be compared with normative data from the tens of thousands of athletes who have taken it in recent years, Collins said.

But Koester said the test is not as accurate without the baseline information.

"Everybody is going to fall in somewhere on the spectrum," he said. "You have to pore over the data a little more, make some assumptions."

Koester said he's heard the stories of kids who supposedly try to do poorly on baseline tests so that their post-concussion scores won't have to be so high. But he said it's not hard to figure out when students are sandbagging.

The big difference in whether ImPACT gets used is whether coaches and trainers are willing to make it a priority and make it mandatory, he said.

High school athletes in the Bend-LaPine, Sisters and Crook County school districts are required to take the ImPACT test, said Craig Walker, head football coach at Bend High School. It's been used in Central Oregon schools since 2001.

"I think a lot of people aren't doing it because they don't want to be held liable for administering the test," Walker said. "They're worried about being sued. The reality is, this saves lives."

Ralph Conradt of Bend, whose son Max suffered a life-altering brain injury while playing quarterback for Waldport High School in 2001, said he doesn't understand why a school wouldn't use ImPACT if it was available.

Bob McKenzie, a former Springfield High School football coach, said he wishes ImPACT had been used when his son Ryan was playing football. He believes it could have spared his son a serious injury that put him in the hospital for nine days after suffering a concussion in a 2001 game.

"If we would have had that in place, Ryan never would have been injured as serious as he was," he said. "He would have been kept out of competition.

"It's good for kids. It needs to be in place."

Laing recovers, slowly

Meredith Laing doesn't remember getting hit in the cheek in Marist's Dec. 4 freshmen basketball game against LaSalle. She didn't go down, and in fact, she finished the freshmen game and was playing in the junior varsity game that followed when she remembers feeling ill and asking the coach to take her out.

She played sports all her young life, mostly basketball and softball. After missing eighth-grade basketball because of a foot injury, she was anxious to return to play hoops for Marist, only to see her season cut short.

The blow left her with a black eye, severe facial pain, neck pain, nausea and pounding headaches. She stayed home from school for a few days and tried to take it easy when she returned to school, sometimes coming in late or leaving class so she could go rest in the office. She sometimes forgot what day of the week it was.

Her black eye turned green, briefly earning her the nickname "Avocado" before it healed. But the chronic headaches have persisted.

"Now that the black eye is gone, people think she's normal. She's not," said her mother, Michelle Laing.

Laing gets emotional describing her "horrible" ordeal.

"It's kind of hard not to cry, knowing you can't do anything," she said, tearing up. "I'm resting a lot, as much as I can. I'm sleeping a lot. And praying. I pray every night about it."

Doctors told the Laings that Meredith may have suffered whiplash as well a concussion. She's trying medicine to prevent migraine headaches. She played catch with a softball over spring break, and wants to join Marist softball team this spring, but until her symptoms subside, she'll stay on the sideline.

HIGH SCHOOL HEAD INJURIES

A 2007 study in the Journal of Athletic Training calculated the rate of concussion in various high school sports. The rates listed below are per 100,000 player-exposures, with each exposure representing a single game or practice

Football: 47

Girls soccer: 36

Boys soccer: 22

Girls basketball: 21

Wrestling: 18

Boys basketball: 7

Softball: 7