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Head Games | Concussions in youth sports, the Lystedt Law and a local response
From afar, Blake Miller looks like any other up and coming high school football coach. He exudes energy, clearly possesses a knowledge of the game and has a seamless connection with the players he works with. Probably because just a few months ago, he was one of them.
During a jamboree in June, Miller, now a senior at Issaquah High School, suffered the sixth concussion of his life and third in the past calendar year, prematurely ending his football career.
"I don't remember it," Miller said of his most recent concussion. "But when I got hit, I knew I was done. It was rough."
Unfortunately, Miller is far from alone.
A concussion is defined by the Center for Disease Control and Prevention as "a type of traumatic brain injury caused by a bump, blow or jolt to the head that can change the way the brain normally works." Symptoms include headaches, nausea, trouble balancing, dizziness, sensitivity to light or sound and concentration or memory problems, among others. Around 90 percent of concussions do not result in any loss of consciousness.
Dr. Stephen Hughes is a primary care physician specializing in traumatic brain injuries at Overlake hospital in Issaquah and has served as the team doctor for the Mount Si High School football team since 1990.
"We want people to be very much aware that a concussion injury, in many cases, is something you can't prove with a medical test (CT scan, MRI etc.)," Hughes said. "A concussion is a collection of symptoms."
Those symptoms are signs the brain is still attempting to recover from trauma and more importantly, they are a warning.
"If you take another injury, the brain has lost it's ability to regulate the environment and you end up with something more serious," Hughes warns.
Few understand that better than the Lystedt family.
Getting back to normal
Victor Lystedt is like any proud father.
"Every time Zack was up at the plate, I would always get butterflies to see how far he was going to hit the ball," Victor said. "When he was on the football field, I loved to watch him run and tackle. As a father, you want to see your son perform."
But all of that changed on a fateful October day in 2006, when the youngster from Maple Valley suffered two concussions over the course of one junior high football game. Lystedt collapsed after the game as a result of severe brain hemorrhaging and eventually had both sides of his cranium removed. He spent nearly three months slipping in and out of a coma.
It was nine months before he was able to speak and over a year before he moved on his own. He was forced to eat from a feeding tube for 20 months.
"You just take little steps and build on them," Victor said. "We just want to get back to normal."
A major piece of getting Zack as close to normal as possible is Dr. Stan Herring, a clinical professor at the University of Washington in Rehabilitation Medicine, Orthopaedics, Sports Medicine and Neorological Surgery. He is also co-medical director of the Seattle Sports Concussion Program and a team physician for the Seahawks and Mariners.
Since meeting the family four years ago, Herring has worked tirelessly not only to aid Zack's recovery, but to spread the message of concussion awareness.
"He's an amazing kid," Herring said of Zack Lystedt. "He's changed all of our lives; Zack has remained a big part of our family."
Now, five years after being injured and months after walking across the stage to accept his high school diploma, Zack is finally beginning to get back to normal. He is set to begin taking a class at Bellevue College in the fall.
In 2009, as a result of Zack's saga, Washington became the first state to adopt head injury and concussion legislation by passing Engrossed House Bill 1824, known since its signing as the Lystedt Law.
The legislation, which is intended to be educational rather than punitive, states in part, "Athletes cannot return to practice or a game until evaluated by a licensed physician trained in the diagnosis and management of concussions and given written medical authorization."
In addition, the law stipulates that only one of five certified professionals (medical doctor, doctor of osteopathy, advanced registered nurse practitioner, physicians assistant and licensed certified athletic trainers) may offer a return-to-play authorization for an athlete under the age of 18 that is even suspected of having suffered a concussion. Student-athletes and their parents are also required to sign a concussion information sheet prior to the participation in school sponsored athletics.
Since the Lystedt Law was adopted by Washington, 28 other states and the District of Columbia have introduced legislation to prevent athletes from returning to competition before deemed safe by a medical professional. While the law creates a set of standards for returning to play after a suspected concussion, surrounding issues such as baseline testing are still up for debate.
Measuring the ImPACT
At Eastside Catholic School in Sammaish, there were 37 documented concussions at the high school level and 18 more in middle school youths during the 2010-2011 school year. Twenty-one of the 55 came in football.
In its first year of playing football, Bellevue Christian School has already seen a rash of concussions including one that may keep a player from participating in basketball as well. The numbers were lower at Sammamish High School in Bellevue, where there were 25 documented concussions across all sports. But one of those involved spinal complications and ended a player's career and three other student-atheletes saw their football season come to an end. Two Totems' football players have already been concussed in the opening weeks of this season.
Both Bellevue High School and Eastside Catholic employs the ImPACT testing system, which is used by a bevy of NCAA athletic programs, over half of the NFL and much of MLB and MLS. The 20-minute test, which was developed in the early 1990s by Drs. Mark Lovell and Joseph Maroon, measures verbal and visual memory, processing speed and reaction time, attention span, working memory and other factors that are then compared to baseline results to determine whether or not a player is suited to return to action.
"I'm really happy with it," EC athletic trainer Kristen Slonksy said. "Nothing is full-proof, but what we do makes me feel safe about putting those kids back out on the field."
Slonsky emphasized that she does not use ImPACT to decide whether or not an athlete has suffered a concussion, but rather as another tool to measure recovery once symptoms have begun to subside. Slonksy also uses a daily checklist where athletes can detail the scale of their symptoms to measure the rate at which recovery is taking place.
While ImPACT is widely recognized as the most comprehensive, scientifically reliable system available for testing athletes who have been concussed, it has drawbacks as well, namely price.
ImPACT offers three yearly packages for schools or organizations that gives access to the testing system. The most affordable includes 75 baseline tests and 30 post injury tests at a cost of $350. A mid-range package priced at $500 allows for 300 baseline tests and 120 post injury tests and the most inclusive package offers 600 baseline tests and 240 post injury tests for a price of $750. Each of the packages are good for one calendar year and additional baseline and post injury tests can be purchased in an a la carte fashion in increments of 50.
At Sammamish High School, players are baseline tested before the season, but not using ImPACT software.
Totems' athletic trainer Cheryl Reed, who spent six years at Skyline High School in the same capacity, has developed her own system of baseline testing using parts of the SCAT 2 (sports concussion assessment tool) test combined with other methods. SCAT 2 tests memory, coordination, balance and delayed recall. She believes her system is more practical and more efficiently executed at the high school level than ImPACT.
"In my professional assessment of the ImPACT software, I don't think it's a usable tool at the high school level," Reed said. "Without neurologists who can read the results, it's not going to be terribly helpful. I know my athletes better than a piece of software."
Reed's replacement at Skyline, Lian Yuen, also uses a modified SCAT 2 testing system and performs baseline tests for Spartans' athletes by request. Yuen said there simply is not enough time to baseline test each and every athlete. 60% of Skyline's 1,395.68 (2010 WIAA average full-time enrollment figure) students participate in one or more varsity sports.
Unlike her predecessor, however, Yuen believes ImPACT is a viable system at the high school level.
"I would love to do ImPACT testing," Yuen said, adding that the system allows baseline tests to be taken by athletes on any computer, meaning they could complete the time-consuming and detail oriented process at home. Yuen also believes the ImPACT model, which varies the memory portion of the testing each time it is taken, would be useful in deterring overzealous athletes from cheating the test by memorizing responses.
Other schools such as Newport and Interlake do not conduct baseline testing for athletes. Phillip Chermak, who is the head athletic trainer for the Knights, says baseline testing protocols are somewhat unproven and out of the price range of cash-strapped school districts.
"Especially in the current economic climate, it's not something that is going to be implimented right away," Chermak said of ImPACT. "I don't know if ImPACT is the final answer, but it's a good first step in getting testing standardized."
A shift in culture
Blake Miller knows all is not lost.
While the Issaquah senior missed a chance at major playing time for the Eagles' state-ranked squad and a possible college football career, stories like that of Zack Lystedt remind him of just how lucky he is.
"Even though it (football) is my favorite sport," Miller said. "I don't want to be brain dead by the age of 30."
Things are turning around for Lystedt as well. While his parents still offer him assistance for most all daily activities, there is progress. After years of assistance from Dr. Herring and countless others, he is able to walk with a cane, carry a conversation and is slowly working his way back to even greater self-sufficiency.
"We get very excited about the new things we get," Victor said. "The fact he can stand next to the sink and brush his teeth is like the longest ball he ever hit."
The Lystedts met with NFL commissioner Roger Goodell and even attended the Super Bowl with him. Goodell has been a feverish advocate for concussion reform since taking over the role of commissioner and has been more than willing to hand out fines for players who cross the line. Herring says Goodell has promised to remain on board with himself and others around the country until every state has adopted a Lystedt Law.
Zack also met with football legend John Madden, who decided after meeting him to modify a feature in his bestselling video game franchise, forcing players who suffer a concussion to remain sidelined. Previously, gamers could simply substitute a player with a head injury back into the game, something they could not do for players with other serious injuries such as ligament tears or broken bones.
National sporting goods retailer Sports Authority is pushing concussion awareness to the public as well with a TV advertisement that has been running during college and NFL games this season featuring Jerome Bettis, known for a punishing running style that earned him the nickname "The Bus". The commercial is to promote a program through Sports Authority where every pair of athletic shoes purchases is accompanied by a donation to ImPACT that will help subsidize the cost of the program for high schools nationwide. If the financial burden is lessened on the already cash-strapped school districts, the hope is they will be able to get on board with ImPACT for the safety of the student-atheltes.
Regardless of the method, it's clear that state legislators, the NFL and even sporting goods retailers are dedicated to changing the culture of football regarding head injuries.
"We have a greater responsibility to get that message out to everybody," Victor Lystedt said. "It's a cultural change. It doesn't make you any tougher to have your brain impaired."
Herring, who has worked around professional sports for nearly three decades, has begun to see that cultural shift take place even at the highest level.
"For the first time in my almost 30 years of doing professional sports, a professional football player came up to me and told me he thought the guy next to him wasn't right," Herring said. "That's a huge step forward. It was nice to see that change socially."
But cultural change is a painstakingly slow process. Until the protocols that are now commonplace at the youth level translate to the collegiate and NFL ranks, that process won't be complete. The torchbearers for that movement aren't those currently in the professional, collegiate or even high schools ranks. It's those playing youth football, those who have an introduction to the game that includes concussion awareness, education and prudence. The Greater Eastside Junior Football Association has clubs based at every 2A, 3A and 4A KingCo school and has a dedication to ensuring those who come through the various clubs understand concussion awareness. John Veentjer has been president of the GEJFA since 2000.
"Player safety is our highest priority," Veentjer said. "Before the coaches are allowed to step out on the field, they are required to take concussion training."
But it isn't just coaches who are getting schooled on the critical importance of recognizing possible concussions and removing the athlete from play. Parents and players are given literature at registration and educational videos and other materials are available online. Club officials can view which coaches have completed knowledge-based concussion tests and remove those who have failed to do so. Veentjer, like Herring, said he is also beginning to see the cultural changes on an individual level, with more coaches and parents reporting instances where youngsters may have been returned to play without proper protocol.
"The culture has changed a lot," Veentjer said, adding that during his days as a player 50 years ago, athletes were denied water, given salt pills and told that getting one's "bell rung" was just good football. "It's gotten a lot better."
While each and every day is still a battle, the Lystedts never lack for motivation. Even after the torturous events they have endured, Zack and Victor still find a way to focus on the positives. Victor said he has been contacted by numerous parents from around the country thanking him and Zack for standing up and being heard on the issue. And while that won't help his son recover any faster or more thoroughly, it provides a type of catharsis knowing that others will not be forced to suffer through what he cannot avoid.
"Because we decided to stand up and move forward with this," Victor said. "I guarantee you he has saved kids' lives."