Ruth Kaiser, a Gulliver Preparatory junior, is an avid team player. In the winter, you’d find her on her school’s basketball team. In the spring season, it’s softball.
“I’ve been playing both sports since sixth grade and I love it,” she said from the last place she imagined she’d find herself as her junior year came to a close: the Baptist Hospital Concussion Clinic, a part of Baptist Health Neuroscience Center.
In March while playing softball, she was struck in the head by another player’s helmet. Ruth, 17, was playing shortstop, not her usual second-base position. The opposing player was on second base, getting ready to steal third. She sprinted before the pitcher released the ball. Ruth was preparing for a bunt and didn’t see the other girl coming. Pow.
“Everything blacked out for about 30 seconds. I was on the ground, didn’t remember what happened, but the light bothered me right away. I covered my eyes with my glove,” Ruth said. “I was so scared. Never in my career playing sports have I ever gotten hit that hard, never slammed into the ground like that — especially playing softball. Never thought I’d get hit playing infield.”
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The good news for Ruth, and other students in Miami-Dade and Broward counties, is that help, in the form of new treatments, a new concussion center at Joe DiMaggio Children’s Hospital in Hollywood and a greater recognition of concussion, is abundant nationwide and South Florida is leading the way.
There is also a push to bring concussion awareness and treatment to middle-school and younger children in both counties. Pre-injury testing is generally implemented in ninth grade, the start of high school. But there are plenty of kids playing in pee-wee leagues in high-impact sports like football, soccer, basketball and the growing popularity of lacrosse. Qualified athletic trainers, armed with knowledge about concussions and how to recognize them, are not required on the sidelines as they are in high school sports.
Aftermath of a sports accident
But until Ruth and her family realized these advances, things got worse after the accident, which occurred on a Tuesday. The school’s trainer advised a hospital visit. Her parents thought she’d be fine with rest. They waited days. A mistake.
She had severe headaches. Nausea. Couldn’t concentrate. Unusual mood swings. She nearly passed out in engineering class at Gulliver the following Monday.
Only then did her family seek treatment for her at Baptist. The diagnosis: concussion.
Before she started physical therapy to alleviate the ill effects of the concussion, Ruth went on a weekend trip to California. She awoke in her room at 1 or 2 that morning. The room was spinning, she thought. Ruth finally mustered the strength two hours later to get out of bed and alert her mother in the other room. “I thought I was walking straight in the hall, but I was hitting the cabinet. That is what she heard,” Ruth said.
The federal Centers for Disease Control and Prevention estimates that 1.6 million to 3.8 million concussions occur each year in the high school age group and that 5 to 10 percent of all athletes will experience a concussion in any given sports season.
The concussion clinic at UHealth-University of Miami Health System sees about 200 concussion cases annually, said Gillian Hotz, Ph. D., the clinic’s director.
Richard Hamilton, Ph.D., clinical director of Baptist Health South Florida’s brain injury rehabilitation programs, said Baptist has had about 150 visits so far this year before football season has even started. Increased awareness has led to the steady numbers. Most kids and their parents are starting to get the message and not postponing visits to clinics.
Football is still the top sport for male injuries while soccer accounts for the most female injuries. Females are more susceptible to concussion.
“The speculation is that females may be more likely to tell someone when they are not feeling well,” Hamilton said. Girls also have weaker neck muscles compared to males and so are more vulnerable and can take longer to recover. The rotational forces of the head twisting on impact cause more damage. Athletes are encouraged to strengthen their neck muscles through weight training and exercises to reduce some of that risk.
Today, there are more resources to treat concussion. Baptist Hospital’s concussion clinic came aboard about nine years ago. Nicklaus Children’s Hospital added a concussion treatment program in early 2013 under Dr. John Kuluz, director of traumatic brain injury and neuro-rehabilitation at Nicklaus. The newest clinic, at Joe DiMaggio, opened in the spring.
“We identified what we thought were some barriers to care for patients with head injuries in South Florida. Patients were having a hard time getting timely care,” said Dr. Matthew Fazekas, a pediatric sports medicine physician who was brought to Joe DiMaggio from Boston Children’s to develop the program. Joe DiMaggio now has concussion clinics in Hollywood, Coral Springs, Weston and Boca Raton.
Baptist recently launched a new research initiative with the Grey Ghost football program in South Miami. The hospital purchased 100 Riddell Institute football helmets equipped with special sensors and donated them to the youth league’s players. The sensors send messages to laptops that athletic trainers can monitor. If the sensor alerts an adult that an impact has occurred, the player is automatically pulled from play and evaluated on the sideline.
“This is the group I’m most concerned of because the younger brain is more affected, more early concussed,” said Baptist’s Hamilton. He treated Ruth after her softball injury.
“We’ve been a model program for the rest of the country,” said UM’s Hotz, after returning from a recent sports concussion meeting in Chicago.
UM and Miami-Dade, the country’s fourth-largest public school system, teamed to catalog and treat concussions in every public high school, for every sport. Since the initiative began about five years ago, the incidents and outcomes of more than 600 concussions have been recorded. Broward has a similar arrangement with Joe DiMaggio and the Broward School Board.
The concussion program at UM originated in 1996 with Hotz and neurologist Kester Nedd, alongside Cheryl Golden, former instructional supervisor for Miami-Dade County Public Schools. “She had the vision to be proactive about concussion management years ago when we got legislation passed and help from Ransom,” Hotz said.
She is speaking about the university’s initial pairing with Ransom Everglades School in Coconut Grove, along with The Miami Project to Cure Paralysis. The institutions began to raise awareness of concussions in sports and to raise money to help schools in Miami-Dade adopt ImPACT testing to get a baseline reading for all public high school athletes. Many private schools also joined the program.
ImPACT gathers cognitive information from students about memory, reflex and timed situations pre- and post-injury. The data are compared after an athlete is injured to determine if his or her skills have deviated from their baseline figures. If so, treatment, which can be as simple as rest or physical therapy for more complicated concussions, can begin.
A state law passed in 2012 requires that any student-athlete suspected of sustaining a concussion must immediately be pulled from the playing field and receive medical clearance to return to play. To put more qualified eyes on the playing fields, Miami-Dade and Broward school boards hired athletic trainers for all public high schools so that there is someone trained to recognize signs of concussion.
IPAS goggles and educational video
Dr. Michael Hoffer, professor of otolaryngology and director of the Department of Otolaryngology’s Vestibular and Balance Program at UHealth, has been testing a portable, head-mounted goggle system that is designed to diagnose mild traumatic brain injuries (TBI) while players are still on the sidelines.
“In 4 1/2 minutes, we can have a 92 percent accuracy on who has mild traumatic brain injury. We are beginning to conquer one of the biggest barriers, and that is accurate diagnostic and accurate prognostic information,” Hoffer said. “We are testing the goggles on high school athletes in the Miami and Broward areas and on college athletes and professional athletes.”
Hoffer, with a $500,000 grant from the NFL, Under Armour and General Electric, is researching whether this system is effective at diagnosing a mild TBI and, at the same time, ruling one out.
Developed by Neuro Kinetics, Inc., a Pittsburgh-based company and partner in the grant, the I-Portal PAS goggle’s software records eye movements, balance and reaction time to determine whether an athlete who has taken a hit to the head can return to the field or should seek medical attention.
To spread awareness at the harder-to-reach elementary and middle school groups, along with their coaches and parents, Hotz has developed an educational, interactive online video game to teach little kids how to play football more safely. “I had to figure out how to educate little kids; that’s very challenging,” she said. Enter the 25-minute video game.
“We are trying to get all youth football leagues to play it before the season,” Hotz said.
Hotz is working on adding a soccer game component to Sportzsafe and plans to showcase the game on ESPN at the end of July.
Meanwhile, Ruth, the student-athlete who took a hit during the softball game, has recently been cleared to return to activity. She was an interesting case, her doctor said, because she was at a higher risk for a longer recovery time from a concussion. She had previously suffered two concussions — once as an infant, another time at age 4 or 5.
“Most kids and adults recover quickly if managed properly,” Hamilton said, citing a couple weeks as the usual period for 90 percent of people.
But “the miserable minority,” as he calls it, can have lingering symptoms post-concussion for months and, like Ruth, require physical therapy. Some factors that add to the recovery time: a history of concussion, attention deficit disorder, learning disabilities.
Psychological factors may also prolong recovery, Hamilton said. “If parents have anxiety, that prolongs children’s recovery. If they are ‘nervous Nellies’ to begin with and that is communicated to the child, that can protract the recovery. That is why [it’s important] educating the parents.”
Stay in sports
The message from all the experts: Team sports offer social, physical, competitive and goal-setting attributes that benefit children.
“The motto is, ‘When in doubt, sit them out’” if a concussion is suspected, Fazekas said. But when all’s well, he said, don’t avoid sports to avoid concussions.
“Let them play and let them have fun,” Hotz said. “The positives outweigh the negatives, and the best way is for a kid to play a team sport.”
As for Ruth, she said she has learned her lesson and that her story sends a message to her peers.
“I hope when people experience a concussion, they don’t shy away. Don’t keep it to yourself. If you need treatment, don’t be afraid to get treatment,” she said. “I learned so much about what really is a concussion and how it can change a person.”
A concussion is an injury to the brain usually due to a jarring or an impact from a fall, accident or while playing contact sports. Sports like football, soccer, lacrosse, basketball and baseball tend to lead the number of concussions. Concussions are treatable.
The usual treatment is rest — for the body and the brain. In some cases, physical therapy may be necessary.
▪ Headache — sharp or throbbing or both.
▪ Balance problems
▪ Difficulty in communicating or concentrating on tasks.
▪ Sleeping more or less than usual
▪ Blurred vision.
WHERE TO GET HELP
Baptist Hospital Concussion Clinic, 8900 N. Kendall Dr., Miami. Call 786-596-6520 or visit baptisthealth.net.
Joe DiMaggio Children’s Hospital, 1005 Joe DiMaggio Dr., Hollywood. Call 954-538-5566.
Nicklaus Children’s Hospital offers concussion testing/evaluations on Tuesdays and Wednesdays at its main campus, 3100 SW 62nd Ave, Miami, and at its West Kendall Outpatient Center, 13400 SW 120th St. on Mondays. Call 786-268-1789.
A conference on the latest in concussion treatments will be held from Oct. 21-23 at the Marriott Hollywood Beach. The conference is for doctors and health professionals, coaches, athletes, parents and the media. For more information, go to http://ultimateconcussionconference.com/