More than a bump on the head

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On Feb. 10, Will Stephan hit his head on the concrete floor during a basketball game. His mom, Marjorie Davis-Trimm, didn’t think much of it. Will got up and walked off the court, and the final three minutes of the fourth-grade Over the Mountain game proceeded.

But in the days to follow, Will, a rising fifth grader at Hall-Kent Elementary, was more tired than normal. Then his speech started to slur. He was confused. He couldn’t remember anything. When getting out of the car, he forgot to unbuckle his seatbelt. He tried to throw away dishes instead of putting them in the dishwasher.

Will was diagnosed with a concussion, a type of traumatic brain injury (TBI) caused by a bump, blow or jolt to the head that changes the way the brain normally works.

Three months later, he was still not able to attend school. He looked fine on the outside, but he was constantly tired and had a headache.

The effects of traumatic brain injury are far-reaching, affecting thinking, sensation, language and emotions. Resting is critical because brain injury depletes brain energy. If a student is studying a lot, the brain has less energy to repair itself.

As a part of his brain rest, Will is not permitted to watch TV, play  computer or video games, read, listen to music or be in bright light. Many of his days are passed lying on the couch, playing with clay or bird watching. He grows faint after going somewhere for more than 30 minutes, and he always wears sunglasses due to his light sensitivity. His energy might surge, but it dies away after a few days.

In the classroom, traumatic brain injury might manifest itself in complications with memory, new learning, attention and processing speed, as well as a decreased frustration tolerance.

Increasing incidents of injury

Will and his family are not alone. He is one of at least four kids in Homewood, including his basketball teammate Michael Baker, who have sustained mild traumatic brain injury in past six months.

Prior to 2010, the concussion clinic at UAB Sports Medicine at Children’s of Alabama saw about 25 concussions a year. From August 2010 to May 2011, that number jumped to 60 concussions and from August 2011 to May 2012 to 340 concussions. The clinic is on track to see about the same number this past school year, according to Sports Medicine Director Drew Ferguson.

Dr. Joe Ackerson, a local neuropsychologist who has treated Will and others in Homewood, has gone from seeing a handful of brain injury cases a year in the mid-1990s to seeing a handful each week. Some days he sees up to three new cases.

According to Ackerson, the increase is due in part to greater awareness about head injury that has made people better at identifying it, and in part because of an over-emphasis on competitive sports at younger ages when bodies and brains might not be ready.

A long-term struggle

Back in Homewood at the ballpark one day, a friend of Davis-Trimm dragged her over to Ronda Reynolds.

“You have to meet her, both your kids have the same thing,” the friend said.

Reynolds was already four months into the ordeal when Davis-Trimm’s journey began and was able to share information about doctors and treatments. Reynolds’ daughter, Karli, a rising freshman in Homewood High School, was kneed in the forehead during a cheerleading stunt on Oct. 3.

Seven months later, she is still not cleared to return to cheerleading. It wasn’t until early May that she was able to take regular tests with medications and to return to the bright, noisy lunchroom, which could easily drain her brain energy. She still could not take standardized tests at school’s end, and she still has trouble retaining information.

As time has gone on, she has become intimidated by social situations, wanting her mom by her side and getting down because she doesn’t get to interact with her friends.

“Not knowing when it’s going to get better is scary, it affects your whole family,” Reynolds said.

This spring Karli gave a try at the thing that makes her most happy. She did well in the first two days of cheerleading tryouts, but on the final day her mom said she couldn’t handle her nervousness and didn’t make the squad.

“In a 15 year old’s mind where cheer is everything, it was devastating,” Reynolds said. “You do have to let them do stuff in moderation because kids end up going into depression [without doing anything]. Being a teenager is hard anyway.”

Reynolds said one of the most frustrating things has been that others thought she was making a bigger deal of the situation than necessary.

A lot of football moms tell stories about how their kids recovered from a concussion, she said. But Reynolds knows that head injuries are not all alike. Much like a bruise, a concussion can be an evolving injury

“I always thought it was a bump on the head and you go on with life, but unfortunately it is not always,” she said. “It’s a brain injury, not just a bump on the head.”

Evolving effects on the brain

A brain injury patient can appear healthy from the outside not just during recovery but also soon after the impact. Homewood High School rising senior Joey Crittendon went to the doctor to address a finger injury after a spring break show choir trip with the high school. While there, he also mentioned his head hurting. As it turns out, he also had a concussion from an incident on the trip, although he has not been able to identify the specifics.

A vast majority of concussions do not involve loss of consciousness, according to Ackerson.

“Many times you can’t tell what the severity is initially because it takes minutes or hours to fully evolve,” he said.

Joey has missed about two weeks total of school and still has lingering confusion from time to time. Normally a star student, he has fallen further and further behind in school.

Last year he was first chair saxophone in All-State Band, but when he auditioned this year, he forgot what he was doing part of the way through the exercise and landed third chair.

“You never know when he is going to get confused about what he can and can’t do,” Joey’s dad David Crittendon said.

Joey is living proof that for head injury patients, the ability to do something they would normally do doesn’t mean they don’t have a problem.

“To me the biggest thing is when you have a kid with a concussion they might otherwise appear normal,” Crittendon said. “If you just looked at him, you couldn’t tell that anything is wrong with him.”

Allowing the brain time to heal is the most important part of recovery. The CDC recommends athletes don’t return to play until are they symptom-free and cleared by a health care professional.

Possibly the worst thing a patient can do is get hurt again before the brain fully recovers from the first injury; it can increase the chance of long-term problems.

“If you don’t recover from them completely, it can be life altering,” Reynolds said, “that’s the scary part.”

Preventing head injury

Parents interviewed for this article are advocating for measures identical to head injury prevention regulations: if you see a child get hit in the head, pull them out of the game and get them checked.

Ackerson’s mantras is “When in doubt, sit it out.”

“It’s when they continue to play with a concussion that they increase secondary and cumulative effects,” he said.

Ackerson agrees that parents shouldn’t pull their kids out of organized sports for fear of brain injury.

“In fact, you have a lot more concussions occur outside organized sports than inside organized sports,” he said. “It can happen at any time under any circumstances. If your child is involved in organized sports, you want to make sure coaches and organizations are following state guidelines with training and pulling out kids who get hurt.”

Thanks to a state-wide task force led by Ackerson, Alabama passed a law in June 2011 that requires sports organizations to create a concussion and head injury information sheet athletes and parents must sign. Organizations are also required by law to train coaches on how to recognize concussion symptoms and on proper medical treatment, and athletes suspected of concussion must be pulled out of a game. It was after this legislations passed that Childen’s and Ackerson saw the most dramatic jump in the number of concussion cases.

When it comes to prevention, Ackerson also noted that proper rule enforcement and technique is more important than safety equipment.

The silver lining

All parents interviewed are hopeful their children’s brains will get more rest this summer and return to a normal state. And for kids still suffering, there is a silver lining.

Karli auditioned for the show choir and made it. After eight months, her mom said she is finally starting to get better.

Now an avid bird watcher and painter of birds, Will told his mom he wants to pay back Hall-Kent for the audio text books the school bought him. To do so, he plans to paint a Goldfinch for the Fall Festival auction in October.

“I just started crying when he told me what he wanted to do for his school,” Davis-Trimm said. “There are so many blessings we have received as we have traveled this path.”

Local Concussion Incidents*

Prior to 2010: around 25

2010-11: 60

2011-12: 340

*New concussion cases seen by the concussion clinic at UAB Sports Medicine at Children's of Alabama

National Brain Injury Incidents**

62 percent: Increase in emeregency departments visits for sports-related traumatic brain injuries (TBI) among children and adolescents

71 percent: Sports-related TBI emergency department visits that were males

71 percent: Sports-related TBI emergency department visits that were ages 10-19

Falls: Cause half of traumatic brain injuries in ages 0-14

**Data from the Centers for Disease Control from 2001-2009