When Ainsley Gourlay suffered her first concussion while ski racing her parents, Chelle and Baird, were concerned, but not overly so.
Gourlay's second concussion at another ski race a month later warranted a much different reaction.
"I would not stop my kids from doing what they wanted, but I would not have tossed off her first concussion," Chelle said. "The protocol would have been better. I would have made her wait two weeks at least (before she returned to skiing).
"But I was just a first-time uneducated parent."
Thanks to countless hours of research she is not anymore.
Dealing with 16-year old Ainsley's post-concussion symptoms, including irritability, dizziness, headaches, and inability to concentrate or read, led to a crash course in concussions by Chelle.
"The chemistry and neurology of growing brains is much different than an adult brain. You are going through so much from the ages of 14 to 26. Concussions at a younger age can be more severe than when you are older. I didn't know any of this at the time," Chelle said.
"She missed two solid weeks of school before she could function."
After her second concussion in January of 2006, Ainsley was disallowed from any contact sports for two months and was even banned from doing any activities that would make her blood pressure increase like climbing stairs.
"That was depressing," Chelle said. "For her to be told at that point she could not ski race for a year was a hardship."
Concussions have been a hot topic in the national media lately and with such an active population base it's a story that has local relevance as well.
No less than five high school athletes - and probably more than that since head injuries often go undiagnosed - suffered concussions while playing sports this fall.
And that is a big jump, according to physical therapist and certified athletic trainer John Koth. Normally, he sees one to two concussions per sports season.
And that number could be exceedingly low, given that the Center for Disease Control estimates 300,000 sports and recreation head injuries occur in the United States each year.
"We probably see 10 percent of what actually occurs," Koth remarked.
The frequency and seriousness of the injury warrants a closer look at what matters about the gray matter.
No longer called dings
In the simplest terms a concussion is defined as an injury to the brain caused by a blow.
Depending on the grade of concussion there may be an initial temporary loss of consciousness, confusion, dizziness or nausea.
What is not so simple, however, is the myriad of symptoms both physical and mental a person can suffer after a "closed head injury" in which the skull is not pierced by an object (also called mild traumatic brain injuries).
The brain is composed of soft tissue and bathed in cerebral spinal fluid. A blow to the head can cause the brain to shift inside the skull and even bash into it. The jarring can lead to bruising of the brain, tearing of blood vessels, injury to the nerves and temporary loss of normal brain function.
If the initial injury sounds bad the after-affects can be even harder to deal with.
Hannah Hennessy, a junior at The Community School, suffered a concussion during a soccer game against Wood River on September 23. Seven weeks later she still gets headaches and dizziness during exercise.
Hennessy described the road to recovery
"At first I was getting headaches every day for a week or two. The first week I had to just lie on the couch and watch movies. I couldn't do anything. Then at state (the 3A-state soccer tournament) I got kicked in the face and the headaches started to get worse again. The first week of basketball practice was pretty hard with dizziness and headaches, but now it's getting better."
Almost a year after her first concussion, Gourlay is dealing with similar after affects. "I get headaches constantly and occasionally I get positional vertigo (extreme dizziness depending on position). I am so afraid to back to skiing, but I am going back because I want to."
An ounce of prevention
To prevent future concussions, Hennessy says she will wear headgear designed to protect her cranium during sports.
"It covers your head in case you get hit in the same spot," she said.
The Les Bois soccer club in Boise just purchased similar headgear for 300 players and will make wearing it mandatory.
Mouthguards for hockey and basketball are required for prep players in Idaho and help minimize the effects of a whiplash and contact concussion where the head is whipped back and the teeth gnash together.
Appropriate equipment, especially helmets, is a must for any sport, particularly repetitive contact sports like football and hockey. Helmets are also a good idea when there is the potential to bang your bean, like bike riding or skiing.
Luckily kids born in the last 20 years are pretty clued in when it comes to head protection.
Don Wiseman, Executive Director of the Sun Valley Ski Education Foundation remarked, "For some putting on a ski helmet is more natural than putting on a ski hat."
The wave of the future?
Some physicians advocate baseline testing, which is a set neurological evaluation administered while the person/athlete is healthy and can be referred back to if the person suffers a concussion.
Physicians who support neurocognitive screening say it allows for more objective decision making in the return-to-play process and helps prevent more serious post-concussion conditions, such as second impact syndrome, when an athletes suffers a repeat concussion before the brain recovers from the first.
Koth, who patrols the sidelines at Wood River High School football and soccer games, is a proponent of neurocognitive screening, especially for younger athletes.
"Adolescent brains are not formed. The pathways are not completed. It is not a sound science. It hasn't been completely validated from a scientific standpoint, but I think you have to error on the side of caution."
Koth said the cost for testing is "nominal" but the system has to assigned to a center or group.
"You need an impact-testing site and it has to be licensed to a group. Schools can be a nice avenue," Koth said.
Gourlay concurs, "Multiple minor concussions are really scary, especially in a small time frame. If you have a baseline you have a lot more information. What are we going to do with information? Would you rather they are safe or sorry?"
While Wiseman said he does not know enough about the testing to have formed an opinion, he allowed, "anything that helps us keep our kids safe and healthy is a positive thing. We need to talk about the issues and adjust to new findings."
Old school
There is a famous picture of the New York Giant's Frank Gifford taken in 1960. Gifford is lying prone on the football field with his arms cast up to the heavens while an exultant Chuck Bednarick celebrates the tackle. Gifford retired for 18 months after the hit.
While such brutal fierceness remains common place in the National Football League, the attitude and ideas surrounding brain injuries are evolving.
According to two-time Super Bowl champion and Idaho native Jerry Kramer, the prevailing wisdom when he played in the 1960s was to strap it on and get out there no matter how severe the injury.
"(Concussions) weren't anything out of the ordinary. It was a tough game and you were expected to be a tough guy," Kramer, a guard for the Green Bay Packers, said.
"I vividly remember a concussion when we were playing the Los Angeles Rams. A fellow named Lamar Lundy who had a very large knee got me in the gourd. I couldn't remember any of the plays. I went out and told (Vince) Lombardi, 'Coach, I can't remember any of the play,' and he said, 'just let (Jim) Ringo tell you the plays.'"
"So what do I know? I went out there and Ringo would tell me what to do one play after another. It was kind of uncomfortable not knowing what the hell you were doing. But it was pretty much something you just dealt with."
A week later Kramer found out he had a detached retina from the force of the collision with Lundy. He waited for three weeks to have it fixed, because it was deemed a waste of time to have it repaired during a playoff run.
New and improved
But the pendulum is slowly swinging the other way.
John Blackman, vice-principal at WRHS and the former varsity football coach, agrees that awareness is on the upswing.
"Just this year, (current football coach) Mike Glenn lost two key players and the medical field would not release them to play for two weeks. Before we might have kept them out for one game, but not two."
That's true on the professional level as well.
"The NFL is a lot more cautious because they have more understanding," Kramer remarked.
A study conducted by the Center for the Study of Retired Athletes in North Carolina found that 62.5 percent of retired NFL players (2,552 respondents) sustained at least one concussion during their career with the average being 2.04. Those who suffered three or more concussions (24 percent) are five times more likely than the average retiree to be diagnosed with mild cognitive impairment (one precursor to Alzheimer's disease) and had a threefold risk of depression.
Kramer recounted, "Max McGee used to get so many concussions to tease him we'd thump him on the head and say 'Max's got a concussion.'"
That might not happen if McGee played in today's NFL. In recent years, several players have stepped away from the game, citing reoccurring head injuries, including Troy Aikman, Steve Young, Wayne Chrebet and Idaho native Merril Hoge.
Kramer has witnessed the evolution.
"There is a whole different attitude about taking care of yourself now," he said. "They are like that with every part of the body."
Heads up treatment
According to literature by the Center for Disease Control and Prevention, "all concussions are serious."
If your child suffers a head injury appropriate follow up care includes removing the athlete from play, evaluation by an appropriate health care professional over time, informing the coaches of the assessment, and allowing the athlete to return to play only after being cleared to do so by their doctor.
Parents play a large role in their child's recovery, according to Blackman.
If a parent regards a concussion as serious, they are more likely to seek medical attention and appropriate follow-up care.
"Sometimes parents would follow up and sometimes they wouldn't," Blackman said.
Slow and steady is the protocol promoted by the CDC.
"It's better to miss one game than the whole season."
Concussion signs and symptoms
Symptoms reported by athlete
Headache
Nausea
Balance problems or dizziness
Double or fuzzy vision
Sensitivity to light or noise
Feeling sluggish
Feeling foggy or groggy
Difficulty focusing
Concentration or memory problems
Confusion
Signs observed by coaching staff
Appears dazed or stunned
Is confused about assignment
Forgets plays
Is unsure of game, score or opponent
Moves clumsily
Answers questions slowly
Loses consciousness
Shows behavior or personality changes
Can't recall events prior to injury
Can't recall events after injury
(Source: Center for Disease Control and Prevention)
Sun Valley ski team racer Ainsley Gourlay suffered two concussions in a short time span and is still dealing with side affects almost a year later. Photo by Willy Cook
