- Associated Press - Friday, February 12, 2016

SALINA, Kan. (AP) - When Cole Elmore was tackled in the fourth quarter of a game this past fall against Beloit, the Sacred Heart High School sophomore’s head was smacked around, as he put it, “like a pinball.”

Within minutes, he had a raging headache, the vision in his left eye went black and the left side of his face went numb.

“And he was stuttering,” said his father, Dr. Kyle Elmore, a family physician who quickly assessed Cole on the field and then drove him to Salina Regional Health Center.

“I texted the coach from the ER that he was going to have to find a new quarterback,” Kyle Elmore told the Salina Journal (http://bit.ly/1nZH70d ). “He understood.”

The understanding of the dangers of concussions - and multiple concussions - and how to treat them has grown considerably in the past decade, as has public awareness of the problem.

Five years ago, the Kansas Legislature passed a law that required high school athletes and their parents to read a primer on concussions and concussion treatment and sign it, before students could attend their first practice. The rules also require that anyone suspected of having a concussion be checked out by a doctor and cleared before being allowed to return to practice or play.

About the same time, Salina Regional Health Center began offering free baseline testing for student athletes to determine a student’s cognitive abilities. The results can be used for comparison after a suspected concussion.

“Five years ago, I wasn’t sure where we’d be right now,” said Rachelle Giroux, manager of trauma services at Salina Regional. “I thought maybe it would have faded from attention.”

Instead, she’s seen the National Football League focus attention on the issue. A documentary, “Concussion,” played at Central Mall just weeks ago, and the death of a high school football player in Sharon Springs this past fall brought renewed attention to the issue. Luke Schemm’s death, days after he collapsed on the field, has been attributed to traumatic brain injury.

Dr. Brian Harvey, a Salina physician who is working with Giroux to write a guide for the local medical community to use in treating concussions, said knowledge of concussions is changing rapidly.

Ten years ago, Harvey said, a concussion was considered to have occurred if someone suffered a blow to the head that resulted in loss of consciousness.

“Now, we know that 90 percent of concussions don’t have a loss of consciousness,” he said.

He said research indicates a loss of consciousness as part of a concussion might help protect the brain from damage.

“As late as December of 2014, the treatment was to put the patient in a dark room, no bright lights, no TV, no phone, no school for several days,” Harvey said. “In January of 2015, there were new studies. … Now cocooning is something we’re trying to get away from.”

The goal, he said, was to give the brain a complete rest.

Today, Harvey said, people with concussions can “step back into watching TV or using a cellphone after a few days, maybe 15 minutes at a time, and then step up, with limited homework and limited screen time.”

A student athlete should be completely free of symptoms before returning to play or practice, Harvey said, and “return-to-learn comes before return-to-play.”

One point that hasn’t been changed by new research, Harvey said, is that one concussion makes a person more susceptible to another one, and to permanent brain damage.

The hit Cole Elmore took in the Beloit game in September resulted in his third concussion.

The first occurred at the end of his eighth-grade year, when he fell from a stage at school and struck his head.

Recovery that time involved “sitting around the house in the dark” for about a week before starting to resume normal activity. The accident occurred two days before the end of the school year, so he didn’t lose much class time.

The second concussion occurred in the fall of his ninth-grade year, this time on the football field. It resulted in a “massive headache” and temporary hearing loss. That time, it was two weeks before he was allowed to practice again and three weeks before he was cleared to play.

“He went through the protocols and came out fine,” Kyle Elmore said.

After the third concussion this past September, Cole’s football career was over.

Kyle Elmore sent a text message to the coach that night and broke the news to his son the next day.

“He told me I wasn’t going to play football again, and that really hit me,” Cole said.

His vision didn’t clear for several weeks.

“Concussions are a whole different ball game than even just 10 years ago,” said Ken Stonebraker, athletic director at Salina South High School. “Back in the day, you were expected to be tough, not complain - even to the point of not drinking water.”

His counterparts - Greg Maring at Salina Central and Eric Muninger at Sacred Heart - agree that coaches, parents and student athletes are taking concussions more seriously than in the past.

While football is often singled out, the athletic directors say they’ve seen concussions in nearly every sport, including soccer, cheerleading and swimming. All three athletic directors say a few students every year are sidelined for a time because of suspected concussions, but they couldn’t provide specific numbers.

And, they say, it helps to have a state law that requires a doctor be involved in deciding if or when a student can return to play.

“I think parents are in full support. What I hear is sometimes the athlete doesn’t want to come out and admit there’s a problem,” Maring said. “What takes the pressure off of everybody is they have to go to the doctor if there’s any suspicion they have a concussion.”

Stonebraker also said the Kansas law is helpful in providing guidance.

“We’ve educated kids that this is important and they need to let us know what they’re experiencing,” Stonebraker said. “If a kid has headaches or other symptoms, we don’t mess around with it. It helps us, too, that it’s state law.”

Harvey and Giroux agree that public awareness - coupled with state law - has mostly done away with what Giroux calls “the idea you’re a wimp if you don’t play because you have a headache.”

“I’ve not had a parent say his kid doesn’t have a concussion, that he can play, after a trainer says they can’t,” Maring said.

“It’s getting a lot better - the coaches are coming along,” Harvey said.

He said there is still an occasional issue with private traveling teams, which aren’t covered by the state law.

On those teams, he said, “there’s more pressure to continue to play.”

Medical images, such as CT and MRI scans, don’t show concussions, Harvey said, though there is promising research into a blood test that can detect concussions. Within five years or so, there could be a blood test that could be given on the sidelines during a game that could detect whether an athlete has had a concussion.

For the time being, he said, doctors look at the totality of symptoms. While headaches are reported in 90 percent of concussions, that still means 10 percent of people with concussions don’t have headaches. In short, he said, if there’s been a blow to the head, and concussion symptoms are present, players are sidelined until the symptoms are gone.

Unlike a broken bone, Stonebraker said, a concussion isn’t obvious, which means coaches need to rely on players to report symptoms.

That can be a weak link in the process.

“We work hard to make sure kids understand they need to tell somebody if they experience these things, the symptoms,” Stonebraker said. “We have each kid do a session, meeting with an athletic trainer about things that can happen” because of a concussion.

But Dr. Elmore recalls a couple of years ago when he was working a shift at StatCare and a student athlete came in suffering symptoms of concussion.

“I denied play,” he said.

Three days later, he said, he saw a photo in the Journal of the student playing in a game.

Elmore said it’s possible the parents shopped around for a doctor who would clear their child to play, but more likely the coach was never informed the student had symptoms, so the issue never came up.

“Would I let my kid play football? Absolutely,” Harvey said. “But not when they’re in second or third grade, and with proper training. … and flag instead of tackle.”

“My brother is a high school football coach,” Harvey said. “He’s asked me before are we going too far, are we being too picky, and I’d say no. I’d rather a kid sit out a game or a few games than have a lifetime of headaches - or worse.”

Elmore feels much the same way.

“After I took Cole home from the hospital, I watched my youngest son at Salina Stadium, playing Salvation Army football,” Elmore said.

“I liked playing football, but I know I can’t,” Cole Elmore said. “I guess it’s not what God wanted me to do.”

Elmore said his son has options.

“He’s a great basketball player, and a great golfer,” Kyle Elmore said. “Most importantly, he still has the ability to study, learn and lead a productive life.”

___

Information from: The Salina (Kan.) Journal, http://www.salina.com

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