IT WAS ONE of those embraceable father-and-son moments. Dr. Brian McDonough was driving his son, Brian, home from a grade-school football game, reliving parts of the game, such as Brian's great 80-yard run. There was just one problem - Brian didn't remember it. Brian sat there reticent, wearing a vacant expression. McDonough dismissed it as Brian being gripped by youthful exuberance. Brian's very next game, he took a helmet to the chin, tried to get up and stumbled back down.
This time, McDonough, videotaping the game, saw the hit, immediately put the camera down and went onto the field. Brian had no idea where he was, what the score was, or what was happening. It marked the last time he played organized football.
Concussions in football are a red-hot topic today, with the attention given helmet-to-helmet collisions in the NFL, but at the grade school and high school levels, players are more susceptible to repeat concussions and are more apt to continue playing with an undiagnosed concussion than at any other level of football.
The concussion issue was the top point of emphasis in PIAA rules meetings last summer, officials said. Treatment standards for young athletes are law in nine states; legislation passed in the Pennsylvania House of Representatives in late September, but has since stalled in the Senate.
What happened to Brian was just an example of what could happen - and where matters could potentially lead. Autopsies in 40- and 50-year-olds with high school and college football backgrounds have shown the early onset of Alzheimer's disease, according to Dr. Margaret Goodman, former longtime ringside physician for the Nevada State Athletic Commission, and though "the numbers aren't high, the numbers are still there."
It was something McDonough wanted to avoid for Brian, then a grade-school star who seemed destined to play in high school.
"Brian loved football, and I was really depressed to take this away from him," said McDonough, KYW Radio's medical editor. "I remember telling him, 'When you're 25, I'd rather have you say, 'Dad I can't stand you for not letting me play football,' rather than having to feed you your breakfast from a straw.' "
Brian, now a 5-10, 150-pound Malvern Prep junior, gets to display his strong arm - for the Friars' varsity baseball team. He still runs fast - as an all-Inter-Ac cross-country runner.
He acknowledged, however, he still gets the itch to play football.
"I think my father knows how grateful I am for the decision he made," Brian said. "I know cross-country is the polar opposite of football, but it's still intense; it's still a team sport. I still miss football, but I know anything can happen and one hit can end it."
Brian said it scares him to see the videos of his amazing games in youth football.
"I look back on those games and don't remember a thing; maybe the first two quarters," Brian said.
Ever wonder why you might have made some unwise decisions when you were a teenager, or why your teenaged children act the way they do now? Part of the reason is that the human brain is not considered fully developed until age 25, said Dr. John Kelly, of the Hospital of the University of Pennsylvania. That's why treating concussions is so important.
High schools across the country take concussions very seriously. Washington, Connecticut, Massachusetts, New Mexico, Oklahoma, Oregon, Rhode Island, Texas and Virginia passed laws governing the handling of concussions among student-athletes. Legislation proposed in Pennsylvania is designed to enhance concussion management in youth sports and increase awareness among coaches, parents and players of what the sponsor, Rep. Tim Briggs, D-Montgomery, termed "the devastating, lifelong effects [concussions] can cause when not handled properly."
Dr. Robert Lombardi, the PIAA's associate executive director, said the issue of concussion management is relatively clear-cut.
"We play by a simple rule: When in doubt, the player is out," he said.
"It comes down to how they're caused," Lombardi said. "It's a whole different game at the NFL level, where they don't tackle to tackle; they tackle to punish at the NFL level. At the high school level, they're taught form tackling - how to wrap up."
Locally, many leagues have instituted the ImPACT test - ImPACT is short for Immediate Post-Concussion Assessment and Cognitive Testing - which gives doctors and trainers ways of determining when a player is able to return to practice and able to play after suffering a concussion. It measures such things as attention span, working memory and reaction time.
"It's, without question, far, far different from where things are today when it comes to concussions from when I played," said Haverford High coach Joe Gallagher, who started for the great 1973 St. James city championship team. "I can't even remember guys leaving games because of concussions when I played in high school. They'd crack an ammonia stick; you'd become alert, and then go back into the game. No one was aware of the long-term effects when I played, or even as recent as 5 or 10 years ago."
The largest concerns are recognizing when a player has a concussion and the effects of second-impact syndrome, which is the susceptibility of a teenager to receive another concussion after receiving the first, according to Dr. Robert Cantu, a Boston-based physician and a leading expert on head trauma and concussions.
"It's estimated that 60 to 80 percent of concussions in collegiate and high school football aren't reported to medical staffs," Cantu said. "There is some fault on the part of physicians missing issues, and concussions are hard to diagnose from 40 yards away.
"We did a study using Canadian ice hockey players, putting observers in the stands and asking them if they saw a player acting differently after a big hit. The observers in the stands came out seven times greater being aware of concussions than those on the sidelines. It's why they're hugely unrecognized, underreported incidents."
The complexity of the problem is significant, Cantu noted, considering that fewer than half of the public high schools across the country are thought to have certified trainers at every athletic event. Some leagues mandate it. Others don't - because they don't possess the manpower or budget to have a trainer at every athletic event. In the Philadelphia area, most, if not all, varsity and junior varsity football teams have a certified trainer on the sideline during games, league officials said.
It seems pretty standard among schools in the Delaware Valley that there is a 5- to 7-day recovery policy for allowing a concussed player to practice again - after being cleared by a medical doctor. Some schools still require student-athletes to pass additional tests before they're allowed to compete.
Still, trainers often are pressured to put players back in - and not by coaches.
"Coach Gallagher does a great job with concussions," said Haverford trainer Kevin Murphy, who's been certified for 7 years. "But the pressure, that comes from parents, believe it or not. We definitely do get pressure from parents that want their kids back on that field, and they brush off [head injuries] as if nothing had happened.
"It's not just football. Some of the worst ones I've had in the past were cheerleading parents whose daughter fell and hit her head on a mat. What amazes me is that parents today are from a generation where head injuries were treated differently. They should know better."
Four other trainers, two from the Del-Val League, and one each from the Catholic League and Public League, concurred.
"There is still a lot of ignorance out there when it comes to concussions, and the ImPACT test is not the answer," Cantu said. "It doesn't test vision and balance, and it doesn't test agility. It's very useful for a good assessment of cognitive awareness. But the ImPACT doesn't eliminate the need for neurological assessment. Too many school systems that have it aren't using it appropriately like a red-light, green-light option . . . It's one tool in the tool box; it's not the whole tool box.
"The bottom line is that someone with initial brain injury that picks up a second brain injury, that second trauma does not have to be that severe to cause severe problems. It's where you get brain herniation and death in about the half the cases. The majority of high school football deaths occur because of this."
The important line, Cantu said, is being aware of concussion symptoms, such as an irregular gait and behavior, glazed eyes, memory lapses and headaches. While so much more is known today about concussions - so much more still needs to be discovered. *