THE ORDINARILY energetic boy in the back seat of the car had gone strangely quiet. It seemed odd to Team Comcast "AAA" Youth Hockey Club coach Keith Primeau, who was driving some players back from a game one Sunday a few years ago. The boy - Nicholas Bohatiuk - was then 11 years old, on the opposing team and in his initial year of contact hockey. Play had stopped when suddenly a rival player came up from behind and plowed into him as he stood at the blue line.
Bohatiuk never saw it coming.
He got up and continued playing, but started feeling woozy.
The next day, his father, Dr. Alexander N. Bohatiuk, received a phone call at work: Nicholas went out for recess and began vomiting.
"I remember it like it was yesterday, because we could not believe what had just happened," Dr. Bohatiuk said of what he called "a dirty hit."
"So we had to shut Nicholas down for 2 weeks. He came back and was fine."
The young player had suffered a concussion. Although we have come to think of concussions as a byproduct of pro or collegiate sports, it is also an especially alarming concern for youth-league players, whose brains are still in a stage of development. But it has not been until recently that adults have stepped forward to address it, with the passage of legislation last spring in Washington state that prohibits young players who show any signs of concussion from participating in sports unless they receive clearance from a doctor. The NFL just last week also began running 30-second public service announcements addressing the issue of concussions.
Such forward-thinking efforts have been embraced by the Team Comcast "AAA" Youth Hockey Club, which has received funding from The Children's Hospital of Philadelphia to develop and conduct a concusssion-management program. In an effort to promote concussion awareness among coaches, players and parents, players 11 years old and above received neurocognitive testing, the aim of which is to provide a baseline for athletes to safely play again in the aftermath of a head injury. More than 120 players participated in the "ImPACT" neurocognitive test, which was administered at The Children's Hospital of Philadelphia Care Network's Specialty Care Center in Voorhees, N.J.
Primeau characterizes the program as "cutting edge."
"I think it is revolutionary," said Primeau, the former Flyers star whose own career was prematurely ended by a series of concussions. "I find it very comforting to know that a boy has been tested and I have information to fall back on when I have to decide if a player can play again."
Given his personal experience with concussions, Primeau has been especially circumspect when it comes to handling them. As the coach on the opposing team that Sunday, he remembers the incident that involved Nicholas Bohatiuk, and says now: "For a child to become nauseous and throw up at school is a severe case." Generally, he says the symptoms he has observed in youth-league players have tended to be less acute. But whenever he has had a doubt, Primeau has erred on the side of caution, such as the day he sat down a player who ended up having only a sinus infection.
Would he have done it differently if he had not had his own problems with concussions?
"Absolutely," Primeau said. "And that is absolutely the wrong answer. I do feel as if I would have treated it differently."
The players themselves have become educated in what to look for. Some know more than others. All seem to have some working knowledge. Asked what a concusssion is, Greg Hericksor, 11, of East Rockaway, N.Y., said: "You get headaches."
Kyle Weller, 11, of Philadelphia, said, "When you get knocked out. Sometimes you have memory loss."
Caelan Briere, 11, of Haddonfield, N.J. (the son of Flyers center Danny Briere): "When you get hit in the head really bad. You can get headaches or lose some memory."
Said Marko Bohatiuk, 11, of Newark, Del., Nicholas' brother: "When you get hit hard in the head and something is wrong with your brain, you get a bruise or something."
Primeau said that as a boy he could not have explained what a concussion was.
"No chance," he said. "I was told, 'You just had your bell rung. You just got a bump on your head. Just get back out there.' "
Is there any way for Primeau to know the extent of head trauma he absorbed as a youth?
"No way to know at all," he said. "But I definitely know I played through concussions as a child - having headaches and being lethargic at times and then being hit again. Hopefully, the awareness will be far better with this generation of players."
No one could be happier with the concussion-awareness program than the parents, who each also single out Primeau for special praise. Dr. Bohatiuk said head safety is especially valuable in youth hockey, when "these kids are just figuring out how to time a hit, how to receive a hit and when to pull up." Fellow parent Tom Godfrey, who also has two sons who play, adds that the size differential in youth hockey leaves the shorter ones vulnerable to hits.
Godfrey said, "Because they're smaller, they're down lower."
"As they get to the older levels, the games become a little more aggressive," said Godfrey, who added that his son had his "bell rung" this year. "So you just have to keep an eye out for the symptoms, the headaches and the vomiting."
Dr. Bohatiuk agreed. "Being a chiropractor," he said, "I cannot emphasize enough how important it is to keep the head safe. The head runs the body."
Jean Brubaker added that parents needed to be educated. "It really becomes an issue when the kids start hitting, which they do the first year of peewee," said Brubaker, whose 12-year-old son, Alexander England, plays. "So parents need to be informed as to what to look for. Baseline testing gives you a chance to instantly evaluate the severity of an injury."
Cory O'Conner said he wished that boys under 11 would be eligible for testing. While hitting is not allowed at the squirt level, where his son Parker plays, O'Conner said his son "has been hit with a stick and an elbow.
"Kids run into each other," said O'Conner, of Washington Township. "The earlier [they start testing], the better. I wish they would start this all the way down to 7- and 8-year-olds. You have something to go by."
"I wish it were even younger as well," he said. "The sooner we can establish baselines, the sooner it will give you a foundation that will have a value as you move forward."