Head in the Game Berkshire Program Helps Young Athletes Avoid Repeated Concussions

Andre Waters, a former defensive back for the Philadelphia Eagles, took his own life last fall with a shotgun blast. He was 44.

His brain tissue, however, was comparable to that of an 85-year-old man, according to Dr. Bennet Omalu, a forensic pathologist who believes Waters’ depression was caused by brain damage, the product of too many blows to the head and the resulting concussions.

Had he lived another 10 to 15 years, Omalu told reporters, he would have been incapacitated; at the time of his death, his brain already had characteristics normally associated with Alzheimer’s patients.

That got the attention of the National Football League, which quickly convened a traumatic brain injury committee to investigate the long-term effects of concussions in retired players.

That’s gratifying to Ellen Deibert, a neurologist who runs the Comprehensive Brain Injury Program at Berkshire Medical Center in Pittsfield. After all, she said, if head trauma can destroy the life of a powerful, skilled NFL back, it can also have severe repercussions in high school students.

Deibert, who was trained in neurointensive care, took a special interest in head injury, head trauma, and concussions about 10 years ago, and when she arrived at Berkshire in 2003, she wanted to get involved in community-based projects in that field.

She immediately saw a need for such a program; locally, concussion cases treated at BMC’s Emergency Department have been on the rise, from 427 cases in 2004 to 454 in 2006. The number-one cause of concussions, Deibert said, is motor vehicle accidents, followed by falls and sports injuries.

Concussion is defined as any alteration of mental status due to a sudden and violent rocking of the brain inside the skull caused by a traumatic blow to the head or upper body. Sports-related concussions are most frequent in sports in which collisions and falls are common, such as hockey, basketball, skiing, soccer, and especially football, which has the highest incidence of head injuries of any sport.

“I see football injuries, basketball players who struck the court, ice hockey and lacrosse players,” she said. “And in soccer, people think concussions are from kids heading the ball, but most of them come from trying to head the ball but heading another player instead.”

As recently as 2000, according to the Journal of Sports Medicine, conventional wisdom estimated the total number of sports-related traumatic brain injuries at about 300,000 per year nationally. However, the Centers for Disease Control and Prevention (CDC) estimated this year that the actual number is likely between 1.6 million and 3.6 million, and most of these injuries are concussions.

The disparity in the figures may speak to the difficulty athletes and coaches have in recognizing the signs of a concussion — and, in some cases, the pressure to keep a player in the game. And that’s why the technology Deibert is using in her program is so important.

Deep Impact

It’s called Immediate Post-concussion Assessment and Cognitive Training, or ImPACT, and it’s a tool to help coaches and trainers recognize when a player might have a brain injury, even when the outward signs aren’t obvious.

“We chose ImPACT for our concussion program because of its proven record as a successful neurocognitive testing tool and its ease of use,” Deibert said. “It’s designed to be used along with a thorough history and physical examination. It helps us make a determination about when or if a patient is ready to safely return to play or normal activity.”

The key is the establishment, before the sports season even begins, of a baseline cognitive level for each player.

Athletes are tested in short-term memory, attention span, reaction time, and other tasks to demonstrate what cognitive abilities they have off the field. “As opposed to a neurologic exam that looks at motor control and whether a kid can walk, talk, and speak, this is a more refined tool,” Deibert said. “If a kid gets concussed in the field, he can be given a test to compare to his baseline.”

Deibert has started bringing ImPACT into area schools at the start of each season and administering the baseline test to athletes. But for the program to be effective and keep teens safe, it needs a buy-in from coaches.

“If there’s one thing we know about concussions, especially in the younger athletes, it’s that we don’t want to send them back onto the field symptomatic,” she said. “We have to be careful about sending kids back out there.”

Deibert certainly doesn’t want to see a high-school version of Waters, or even Ted Johnson, an former New England Patriots linebacker who is only 34 but battles severe depression and whose brain exhibits characteristics associated with early Alzheimer’s. Johnson told a newspaper that his troubles started in 2002 when he suffered a concussion during a game, then sustained another one four days later, he claimed, when coach Bill Belichick had him participate in a full-contact practice.

It’s not an isolated story. A study of 2,500 former NFL players by the Center for the Study of Retired Athletes in North Carolina found that cognitive impairment, Alzheimer’s-like symptoms, and depression rises in direct proportion to the number of concussions a player has sustained.

“A thorough evaluation will help prevent premature return to play, which could result in permanent or significant brain injury,” Deibert said.

Time to Sit

Dr. Michael Sefton, director of Neuropsychology at Whittier Rehabilita-tion Hospital in Westborough, introduced ImPACT to schools in the Worcester area last fall, for some of the same reasons Deibert did.

“There is a problem with self-reporting symptoms after concussion,” Sefton said. “Kids aren’t reliable because they want to go out and play.” For that reason, he asserted, concussion is a serious problem in schools that often goes unreported.

Part of Deibert’s program involves training coaches in the outward symptoms of concussion they should look for, a list that runs the gamut from nausea and vomiting to amnesia, disorientation, and blurred vision. When the signs are less obvious, coaches can ask questions and perform simple tests against the ImPACT baseline.

“This is a tool to help prevent mistakes,” she said. “It’s not 100{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5}, but it’s another tool for coaches to use to protect these kids.

“Concussions can be difficult to diagnose clinically, and CT and MRI scans often do not indicate concussion,” Deibert added. “Our goal is to ensure that athletes and individuals are properly diagnosed and returned to play, work, or school as safely as possible.”

And not a moment too soon.