1. North Country LivingEXPLORING THE LIFE AND HERITAGE OF THE ADIRONDACKS
adirondackdailyenterprise.com
Saturday, January 24, 2009
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Understanding and diagnosing concussions in high
school athletics has come a long way; however, the risks are inherent
Shock treatmentShock treatment
Today, those coaches, trainers
and physicians realize that mild trau-
matic brain injuries like concussions
can have much more serious impli-
cations if the athlete is not taking the
care they should after suffering one,
which includes basic bedrest and not
returning to play until all the symp-
toms are gone, symptoms as mild as
a headache or trouble focusing.
One of the most difficult aspects
of treating concussions in student-
athletes is acknowledging when an
athlete has suffered one.
According to the Center for
Disease Control, between 1.6 and
3.8 million sports- and recreation-
related concussions occur in the
United States each year. The vari-
able is so large because concussions
are widely underreported or diag-
nosed by athletes, coaches and
physicians.
However, local high school ath-
letic staff members are actively
working to improve the assessment,
treatment, and communication that
is necessary whenever a student
experiences a concussion.
What is a concussion?
According to Dr. William
Viscardo, Jr., the chief medical offi-
cer at Adirondack Medical Center in
Saranac Lake, a concussion is a
bruise on the brain.
“Your brain is in a boney cham-
ber with space around it,” Viscardo
explained. “It’s the slamming of
your brain into your skull that caus-
es the damage.”
The implications of a concussion
are, most notably, brain cell death.
“Anytime you have any injury
there is a certain amount of cell
death and some cells that are left in
between — not totally healthy, but
still alive,” Viscardo said. “If you
suffer another injury before you are
fully healed from the first, that could
cause those cells to die along with
others that would die from the new
injury.”
Brain cells, unlike skin, bone and
blood cells, do not regenerate. Once
you lose them, they’re gone.
Although brain injuries are not
physically visible, Viscardo said
there are important clues to look for
after a blow to the head.
“With post-concussive syndrome
you can have memory loss, dizzi-
ness, nausea, headaches and/or con-
fusion,” he said.
But when a concussion can mean
the athlete having to sit the bench
the rest of the game and most-likely
more games to come, many players
are reluctant to tell their coaches or
trainers.
Coaches taking charge
“If you’re 17 or 18 years old, you
feel physically invincible and you
want to play,” Saranac Lake Athletic
Director and head football coach
Mark Farmer said. “But no contest is
worth the health of our students.”
Farmer said each coach is
required to attend first aid seminars
and be aware of the symptoms that
follow a concussion. If there is any
question in a coach’s mind whether
a player has suffered a concussion,
they are out for the game, he said.
Since implementing ImPACT
baseline testing on all the student-
athletes, Farmer said coaches and
physicians alike are able to have
more assurance and guidance as to
when a player is ready to get back
off the bench and back in the game,
or the classroom, for that matter.
Both Lake Placid and Tupper Lake
high schools use the ImPACT test
on their student athletes as well.
“We’re always so concerned with
when they’re going to play again,
but at the same time we’re shoving
them into classrooms they’re not
ready for either,” Farmer said.
ImPACT tests a person’s neuro-
cognitive abilities, such as reaction
time and memorization. If an athlete
has a concussion they take the test
again and compare the results to the
baseline they recorded at the begin-
ning of the season. Once the two
match, the student is most likely
cleared to play.
Kevin Moody, the school’s athlet-
ic trainer who attends all football
games and home hockey contests,
said baseline testing is commend-
able on the school’s part.
“It’s another tool in the box, and it
provides objective data that we can
use and the trainer and school
administrators can use to determine
what academic loads the athlete can
handle,” Moody said. “I was a high
school athlete back in the 60s and
recognition of concussions was basi-
cally non-existent. I think awareness
and management of concussions in
scholastic athletes is considerably
better.”
Do the risks outweigh
the benefits?
“Most physicians don’t recom-
mend contact sports, period,”
Viscardo said. “Everything with
medicine is the risk versus the bene-
fit and with kids you have to know
whose benefit we are talking about
— the kid’s? The parent’s? The
coach’s?”
Student-athletes say they play the
game because they love the action,
the competition and camaraderie
that comes with team sports, and for
many of them, that outweighs the
arguably high risk of suffering a
head injury in sports like football,
hockey and lacrosse.
Viscardo, however, questions the
validity of such motivation.
“If you’re a ninth grade hockey
player who, let’s face it, sits the
bench half the game and goes out
and gets whacked, what’s your
hurry to get back in the game?” he
asked.
For adults and student athletes
alike, though, its hard to come
across a person who can say they
have never experienced a good, hard
thump on the head, but Viscardo
warns its the frequency of these
events that can have a lasting effect.
“We’ve all had that happen to us,
and most of us are just fine, but
that’s just one end of the spectrum,”
Viscardo said. “The other end of the
spectrum is Muhammad Ali — box-
ers, they get punch-drunk. Or Mike
Tyson, you know, was he just born
that way? Somewhere there is a
line.”
Viscardo said that line exists at
different levels for every person and
depends on a person’s DNA and the
severity and frequency of a person’s
injuries.
“There’s not research that shows
how many times it has to happen,”
he said. “It’s very hard to predict
who will do poorly and who won’t;
therefore, conservative restraint
should be exercised in all sports.”
And although helmets and mouth-
gaurds don’t prevent concussions all
together, the protection they offer is
far from marginal, he said.
“You wear a helmet so you don’t
die,” Viscardo said. “You have that
helmet on so all you get is a concus-
sion and not a cracked skull.”
By EMILY HUNKLER ¯ Enterprise Staff Writer
SARANAC LAKE —
W
hen today’s high school coaches were ath-
letes and slammed their heads on the ice,
field or their opponent’s helmet, they were
told to get it together, suck it up and get back in the
game, even after losing consciousness in some cases.
Saranac Lake athletic trainer Kevin Moody inspects a player who suffered a concussion dur-
ing one of the past season’s football games. The player’s mother stands by, visibly worried.
(Enterprise photo — Lou Reuter)
Images provided by Adirondack Medical Center show brain scan images of a subdural
hematoma, an injury worse than a concussion, where a vein is torn when the brain slams into
the skull and blood collects between the brain and the skull. The collection of blood is visible in
the top right portion of the scan.
SARANAC LAKE — Sue
Cherny and her husband Tim
Burpoe hold their breath every
time their son Steven hustles out
onto the football field, and after
seeing him knocked unconscious
and taken off the field on a
stretcher and straight into an
ambulance, who could blame
them?
“But Tim said to me, ‘He can’t
play scared, he can’t know we’re
nervous,’” Cherny said.
“We all hold our breath, but we
never tell Steven,” Burpoe said.
“He can’t go out there thinking
he’s going to get hurt because
then he might as well put the pads
away and play tennis.”
Steven Burpoe has had two
concussions in his four years on
the Saranac Lake High School
football team: The first, his soph-
omore year, knocked him com-
pletely unconscious and took him
nearly a month to fully recover
from; the second, his junior year,
was not nearly as severe.
Steven, a wide receiver and
safety, stands at six feet, four
inches tall, much taller than the
defensive opponents whose
whole purpose on the field is to
keep him from catching the ball
— usually that means knocking
him to the ground.
“These two little urchins just
came up and whacked him,”
Burpoe said, describing Steven’s
first concussion-causing impact.
“I think he was out before he hit
the ground.”
Understandably, Steven does-
n’t remember much from the first
incident.
“I have this vague glimpse of
the field,” he said. “I remember
asking the score of the game to
my parents lots of times and
when they would tell me, I
thought, ‘Yeah, I knew that.’”
Cherny said when Steven woke
up Saturday morning in the hos-
pital, he was seemingly normal,
even doing his homework. It
wasn’t until that afternoon that
the symptoms started.
“In the early afternoon he start-
ed getting sick, couldn’t focus,
constant headaches,” Cherny
said.
It took four weeks for the
symptoms to subside. By that
time, the season was long over.
He had missed the most antici-
pated game of the year against
Tupper Lake and didn’t get a
chance to play in the playoffs.
The second concussion was
worse in some ways, though.
Steven said he remembers
being hit hard on the chin and
falling to the ground. He wasn’t
knocked unconscious, but he
needed a teammate to point him
in the direction of the bench.
“I was going inside at half-
time, and I kind of ran into the
side of the door and then Kevin
(Moody) saw me and brought me
off to the side,” Steven recalled.
“He asked me a bunch of ques-
tions with numbers and memo-
rization that I couldn’t answer,
and I didn’t know the date
either.”
Steven said he was upset he
didn’t get to finish the game, but
it was the coming game that he
was really frustrated to miss.
“With the first one I was pretty
messed up, so it did stink not to
be able to play, but I probably
couldn’t have gotten in there any-
way,” he said. “The second con-
cussion, I was really sad because
I had to miss the Tupper Lake
game, and I thought I was going
to get to play. I still had all my
senses, and I was just watching
my team lose. That really stunk.”
For each concussion, Steven’s
parents decided to leave the
return-to-play decision up to the
team’s athletic trainer, Kevin
Moody, and keep emotions out of
the equation.
“It’s really a psychological
thing, not only for the parents,
but its got to be for the kids, too,
because they look OK and they
act OK,” Burpoe said. “I’m glad I
didn’t have to make that decision.
I didn’t want to have that on my
conscious, having guilted my kid
into playing before he was
ready.”
One aspect of Steven’s injuries
that was largely disregarded was
his inability to perform well in
class in the weeks following the
concussions.
After his first concussion,
Steven stayed home from school
on Monday, but returned
Tuesday to take a standardized
test.
“He said he couldn’t even
focus to get his name bubbled in
on the sheet,” Cherny said. “He
had his friend that was sitting
next to him fill it in for him.”
“It’s very frustrating, those
weeks after the concussion, when
the teachers were not informed of
his injury,” Burpoe said, adding
that Steven’s grades fell from As
to Ds and Fs. “We really need to
make a point of managing con-
cussions and letting the parents
who are going through it know
that there are people talking on
their behalf — teachers, guid-
ance counselors, coaches, train-
ers — so they know what’s going
on and know that there are going
to have to be some accommoda-
tions until the kid is far beyond
showing the symptoms.”
Steven said making sure your
teachers know what’s going on is
one of the most important aspects
of recovery.
“I think it’s really important to
tell your teachers, because last
year my teacher’s weren’t
informed, and I took two math
tests and I just really bombed
them,” he said.
Thankfully, Steven made it
through this year’s season with-
out incident and not only did he
help the Red Storm win the
Mayor’s Cup against Tupper
Lake, but they made it to the state
semi-finals, too.
Steven now wears a specially
designed mouthgaurd and chin-
strap to help prevent concussions.
“Because he is so tall, it was
blows that were underneath the
chin or close to the side of the
chin that caused these concus-
sions, that’s why we looked into
the chinstrap and mouth guard,”
Burpoe said.
Despite the fear and worry
Steven’s time on the field may
cause his parents, they fully sup-
port him and look forward to him
possibly playing in college next
year.
“As a parent, you can’t be
overprotective, then nobody
would play football,” Burpoe
said. “It’s a contact sport. The
idea is to knock the other guy
down, not pull the flag from their
belt. That’s the whole essence of
the game and concussions hap-
pen.”
“And I’ll be holding my breath
through all of those games, as
well,” Cherny added.
On the field, in the stands and in the classroom
Tim Burpoe and Sue
Cherny, parents of senior
wide receiver and safety
Steven Burpoe, show
their team spirit when
they attend the Saranac
Lake High School foot-
ball games, despite worry
of further injury to their
son.
(Photo provided)
‘I have this vague glimpse of the field. I remember asking the
score of the game to my parents lots of times and when they
would tell me, I thought, Yeah, I knew that.’
Saranac Lake High School Senior Steven Burpoe