"You don’t need to lose consciousness to get a concussion."
It’s a statement pediatric sports medicine physician Dr. Jennifer King emphasizes to parents and young patients when dealing with head injuries received during football, cheerleading, soccer, wrestling and other activities.
Pacific Buddhist Academy student Sam Sueoka came to King after seeing his pediatrician, complaining of what he thought was a neck injury. The 15-year-old had just finished his junior varsity soccer season for Pac-Five and had jumped to the wrestling program to continue his conditioning.
But during practice "a heavier teammate of mine tried to pin me, and while I was trying to get out, he ‘pancaked’ me and his forearm came down on my head," Sueoka said. "I got a nosebleed from that, but since I usually get those in wrestling, I didn’t think it was anything serious."
But it turned out it was. When Sam got home, he told his parents Ross and Ann Sueoka that "I felt out of it, and my memory was kind of fuzzy."
When Sam came home that day, "he was subdued and complained of a headache," his mother said. "While I was watching him afterward, he’d get so forgetful that it was getting scary. I know he’s usually not the most organized person, but he was way off. He was taking a lot of naps."
A couple of days later, Ann Sueoka received a call from his school saying her son was complaining of sharp pains.
When he was referred to King at the Kapiolani Orthopedic Associates office in the Kapiolani Medical Center for Women & Children, the physician determined the teen had suffered a first-time concussion that included an immediate loss of memory that lasted for about a half-hour.
Concern over concussions in both professional and amateur athletes has been growing in recent years as mounting medical evidence shows that repeated blows to the head during sports can result in long-term brain damage. Coaches, athletic trainers and parents who in the past might have told young players to "shake it off" after a hard hit are now more aware of concussion symptoms and watchful for potential injuries.
That’s one reason reports of concussions among young athletes in Hawaii has been rising, according to King and other experts.
Reports of concussions among public high school athletes in Hawaii increased nearly 50 percent in a two-year span, to 314 in the 2009-10 school year from 213 in the 2007-08 academic year, according to the Department of Education.
In the current year, 407 concussions were reported in just the fall and winter sports combined. Data for the just-concluded spring season were not available.
More than half of concussions were sustained by football players, the DOE said. Other boys and girls sports reporting a relatively high number of cases include cheerleading, soccer, wrestling and judo.
In 2009, Washington and Oregon became the first states to pass legislation specifically addressing concussions in scholastic sports. As of March of this year, 13 more states, but not Hawaii, had followed suit.
The laws require preseason training of coaches to recognize the signs and symptoms of concussion and how to seek proper medical treatment; no same-day or day-after return to play for players who exhibit symptoms; and no return to play until the player is symptom-free and has written clearance and release from the treating medical professional.
With children involved in year-round sports at younger ages, worries about concussions and sports injuries, in general, has reached down to neighborhood playgrounds and youth leagues.
"I’m seeing 10- to 13-year-olds on a regular basis," King said.
"We think the rise in incidence is a little of both better reporting and more concussions. Kids are practicing and playing more all year round than before, so there is more risk exposure."
The American Academy of Pediatrics identified the same problem in a recent study and published guidelines in September recommending that youngsters undergo medical evaluation before being cleared to return to play. The guidelines state that following a concussion, the athlete should be restricted from physical activity until symptoms disappear, which normally takes seven to 10 days but for some could take weeks or months.
In Sam Sueoka’s case his parents and King agreed the student should be taken out of school to rest.
"Being there was taking a toll on him mentally," said Ann Sueoka. "So during that two weeks of downtime, Sam didn’t do any schoolwork, texting or being on the computer, no TV" — activities that can aggravate symptoms — "and reading for only short periods of time."
Starting next year, reports Ross Oshiro, DOE’s coordinator for athletic trainers, more public high schools will be implementing a computerized concussion evaluation system called ImPACT (Immediate Post-Concussion Assessment and Cognitive Testing). The program includes preseason neurological tests measuring verbal and visual memory, motor speed and reaction time.
Once base-line scores for individual athletes are on record, athletic trainers, coaches, school nurses and physicians will be able to repeat the tests to determine whether an athlete who has suffered a knock on the head shows signs indicating a possible concussion.
"We want to compare all base-line scores, not just ImPACT," Oshiro said. "ImPACT is not the sole criterion to return to play. We look at all assessments. Most of the DOE schools will have the ability to run base-line tests and post-injury assessments using ImPACT next year."
Oshiro added the ImPACT system will be expanded next year to 39 of the 43 public high schools statewide. Although it is not mandatory for students to undergo testing, he said it will be "highly recommended."
King said that when student athletes from participating public schools come to her for treatment, she will be able to access their base-line test results that were collected at school.
She added that even if the athlete is cleared to play, there is a gradual five-day progression period before full participation is allowed.
With the rise in reported concussions, "increased awareness by coaches, parents and athletes is what concerns us," Oshiro said. "I actually want to see the number of reported concussions go up because it shows that increased awareness."
To that end the Hawaii Athletic Trainers’ Association is holding its 16th annual symposium for coaches, parents and athletes from 6 to 8 p.m. June 2 to provide information on concussion awareness as well as nutrition and hydration. The free event will be held at the University of Hawaii-Manoa Physical Education Complex.
No similar system or policies are in place for club sports play, although league organizers are aware of the growing concerns over head injuries, said Scott Keopuhiwa, president of the Hawaii Youth Soccer Association. He said HYSA’s parent organization, US Youth Soccer, recently came out with a new awareness campaign.
"At a USYS conference I attended in the late part of February, we were given information on concussions and the importance of addressing the issue. Even though there is no official policy at this time, we’re very cognizant of the problem."
With about 5,500 players statewide, Keopuhiwa said that "at our state-sanctioned tournaments during the spring, winter and fall, we make sure we have high school athletic trainers at the events."
The Pacific Big Boyz Football Conference is also addressing the problems of head injuries.
"It’s a trickle-down effect from what’s being happening on the pro and college level," said league president and commissioner Muao Ava, whose organization gives boys ages 10 through 15 additional football play as they shift from Pop Warner to high school.
"We’re very cautious. We make sure all our kids wear certified helmets. We had a couple of boys last year who got head injuries who we kept out of play for a couple of weeks," Ava said. "There was one incident this year where I saw one boy get hurt, and I walked over to him and saw he was in a bit of a daze. His parents wanted him to go back in to play, but when he stood up he was still wobbly. So I talked to the parents to keep him out.
"It’s not like the kid isn’t tough enough that he can’t take a hit.
"Our game commissioners watch over the games, and a majority of fields have medical people in attendance," Ava said. "Players were taught from Pop Warner, and we stress in our league as well, not to ‘spear,’ leading with your head. When you go in, keep your head up, hit with the shoulder and wrap around. It’s not about winning or losing if a star player gets hurt. We’re not going to send him back in. We make sure our coaches go to clinics to be aware of the problem."
As for Sam Sueoka, he might have stepped away from wrestling, but he’s back playing soccer, participated in track and is paddling with the Kailua Canoe Club.
"Dr. King was great, and we learned a lot from her," said his mother, Ann. "It’s just about being careful with Sam, and our awareness and knowledge has made it better and safer for him."