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Putting heads first

High schools and educators are taking concussion injuries seriously

At South Shore Hospital’s Concussion Clinic, Dr. Janet Kent examines Zack Lenhardt of Duxbury, who suffered a concussion while playing football. At South Shore Hospital’s Concussion Clinic, Dr. Janet Kent examines Zack Lenhardt of Duxbury, who suffered a concussion while playing football. (David L. Ryan/Globe Staff)
By Stephanie S. Daly
Globe Correspondent / December 20, 2009

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Steve Lenhardt remembers clearly when his son was knocked out during a drill at football practice this fall.

“I can picture the day when he got the concussion,’’ the Duxbury resident said, “just sitting on the bench, staring into space.’’

Zack wasn’t the first member of the family to have a concussion; his older sister suffered one while attending hockey camp 2 1/2 years ago.

“They’re just blank. You can just tell they’re not functioning 100 percent,’’ Lendhardt said of his children in the wake of their head injuries. “It seems like something’s disconnected.’’

But there was one major difference between the children’s situations: In Zack’s case, Duxbury High had become more aware of concussions and better equipped to deal with such an injury.

The danger of head injuries and concussions has been a hot topic nationally this football season, particularly with the publicity surrounding cases of star quarterbacks Tim Tebow of the University of Florida and Ben Roethlisberger of the Pittsburgh Steelers. At the same time, new studies have indicated long-term harm from concussions suffered by many former National Football League players.

While the news is raising awareness of concussion in professional sports, concerns are also filtering down to the high school level.

High schools across the country have been adding programs to monitor concussion in their athletes. In this area, the trend has picked up in the last few years. Duxbury High added it last school year, and Scituate joined this year, bringing the total on the South Shore to about 15, including Cohasset, Hingham, Marshfield, Hull, and Abington, Norwood, and Dedham. Statewide, more than 60 high schools have such programs.

“It’s no longer looked at as, ‘Oh, he got dinged, shake it off,’ ’’ Hingham High School athletic director Margaret Conaty said of the changed attitude around concussion. The program “has educated not only our students, but our parents, of the potential seriousness of a head injury.’’

The programs have implemented a much more accurate way of determining when a student is able to return to action. And some schools - including Scituate, Duxbury, and Hingham - now recognize that students who suffer concussions may need special accommodations for tests and other schoolwork.

The main medical tool is the ImPACT system, which has revolutionized the way concussions are monitored.

Immediate Post Concussion Assessment and Cognitive Testing is a computerized test, developed by doctors who now direct the University of Pittsburgh Medical Center's sport medicine concussion program, that measures brain function and can determine when a concussion has occurred and when recovery is complete.

“It’s a neural cognitive testing. It’s a series of tests that measures processing speed, reaction time . . . essentially it measures how the brain functions,’’ Marge Rossi, the nurse in charge of the ImPACT program at Scituate High, said about the test. “I tell the students it’s like taking your brain to the gym.’’

Athletes take a baseline test before the sports seasons in their freshmen and junior years, and the results are kept on file. If a student suffers a concussion, he or she retakes the test, and a doctor can compare the scores to determine the extent of the injury.

The test “adds value because it is actual data that shows you how the brain is functioning, as opposed to the subjective symptoms that the athlete is telling you,’’ said Dr. Janet Kent, who is medical director of rehabilitation services at South Shore Hospital in Weymouth and runs the Sports Concussion Clinic there. The clinic serves only patients 18 and younger, a sign of how common concussions are among high school athletes.

In Zack Lenhardt’s case, the concussion program at Duxbury High and the ImPACT test had a significant effect on his recovery.

Zack, a 14-year-old freshman, was given the ImPACT test at school before the football season. For weeks after suffering his concussion, he experienced headaches, dizziness, and sensitivity to light and noise, and had trouble concentrating.

Earlier this month, after abstaining from sports and attending physical therapy with Dr. Kent at the clinic, Zack took the test again. His scores were close enough to his baseline results for him to be cleared.

“In the past, there’s been no way to really know when the kids can go back to play,’’ said Judy Collins, the nurse who does the baseline testing at Cohasset High School, which has had a concussion program for a little over a year. “This helps us know where they started with their cognitive skills.’’

Previously, doctors would monitor concussion using physical evaluations and the patient’s reported symptoms, but subsided symptoms are not a sure way to tell whether an athlete has fully recovered.

“With an ImPACT test instrument, we have discovered that after roughly 10 to 14 days, 43 percent [of student athletes] feel better and 57 percent still have abnormalities on the ImPACT test,’’ said Dr. David Morin, who see patients at the clinic and used to work with the Scituate High football team. “All of those kids would have been sent back to play before they were truly healed from their traumatic head injury.’’

One condition that can occur after concussion is called post-concussion syndrome, in which symptoms linger for at least three months.

An athlete who resumes playing too soon is at risk of second impact syndrome, in which a second concussion occurs before the first one is fully healed. Second impact syndrome causes massive swelling of the brain, which can result in serious neurological damage or death.

“High school kids are 40 times more susceptible to the negative effects of concussive events as opposed to professional athletes,’’ said Morin.

Dr. Robert Driscoll, who is director of the trauma department at South Shore Hospital and started the Sports Concussion Clinic, has seen the effects of concussion both professionally and personally.

Three of his four children suffered concussions playing high school sports, which was one of the reasons he introduced the concussion program at Hingham High about five years ago. Driscoll’s daughter Lucy was injured when her head hit the gym floor during a cheerleading stunt at Hingham’s Notre Dame Academy.

Lucy was given the ImPACT test after her concussion and it was not until she had difficulty on that test and in her schoolwork that she realized the extent of her injury.

“I was sort of the whole time trying to be like, ‘It’s fine, I’m fine,’ but it was really a shock when I did so badly on the test,’’ Lucy said. “Then after I did poorly on my math quiz, I realized maybe this was more serious than I thought.’’

The idea that students who suffer concussion need rest from school work is another concept that has come out of these high school ImPACT programs.

“School is very difficult when you’ve had a concussion. I think of it as your brain being on a treadmill. It can be overwhelming after suffering a concussion,’’ Kent said. “We’re working with teachers so that these kids don’t see their grades drop.’’

This idea of brain rest, not just physical rest, is becoming better known among teachers and faculty members and has led to more academic accommodations for students who have had a serious concussion.

When Zack suffered his concussion, his guidance counselor e-mailed all of his teachers to inform them of his injury.

In Lucy’s case, she was able to reschedule a quiz she had missed. Both Zack and Lucy also were given the option to miss some school as excused absences, if necessary.

“When we were growing up, who knows how many concussions we got,’’ said Zack’s father. “It’s nice to know that the medicine’s trying to catch up.’’

Stephanie S. Daly can be reached at sdaly@globe.com.