Gearing up to prevent—and treat— concussions among student-athletes

Leah Hunsinger with her parents, Kitty and Dan

Leah Hunsinger with her parents, Kitty and Dan

Approximately 300,000 Americans suffer sports related concussions each year. Last winter, Leah Hunsinger of Gaithersburg became one of them.

The 17-year-old field hockey player didn’t see the hard hit to the head coming.

“I don’t remember falling. I just remember hurting on the ground and then opening my eyes,” says Leah, who graduated in June from Quince Orchard High School.

It happened during a January tournament for her club field hockey team.

Her father, Dan, saw it all from the stands. “Normally when you fall, you put your hands up to brace yourself. But when her teammate accidentally knocked her shoulder into Leah’s head, she just fell flat and smacked her head on the ground,” he says. “Basically, she had two blows to the head within a two-second period.”

Though it was not clear at the time, Leah had suffered a concussion.

“A concussion is a mild traumatic brain injury. A blow to the head, like in Leah’s case, or a hard tackle in football, can cause signs such as loss of consciousness or confusion, headache, dizziness and cognitive impairment,” says Marc DiFazio, M.D., director of pediatric neurosciences at Shady Grove Adventist Hospital and Leah’s neurologist. “Acute signs of a concussion may not appear for hours or even days.”

In fact, other than seeming dazed, Leah’s serious symptoms did not appear until the next day at school. “My head really, really hurt,” she says. “It was just overwhelming.” The headache lasted about four months.

Taking Concussions Seriously

It was the first concussion for the standout player and multisport athlete who excels at field hockey and lacrosse. It was something to monitor, especially since Leah asked her club coach to return to the game.

“As a competitor, Leah wanted to keep playing, but as her dad and a pediatrician, I knew to take her home,” Dan Hunsinger says. He also knew what to look for, and kept a close eye on her mental and physical symptoms following the game.

Head injuries are concerning in children; their brains and bodies are still developing, Dr. DiFazio says. “A brain injury not only affects balance and coordination, but it can also affect the educational experience,” he says.

Leah, a straight-A student, admits she had trouble concentrating in school, especially on complex math problems. In fact, for the duration of her four-month-long headache, she had to “rest” her brain and refrain from activities. Dr. DiFazio provided a number of behavioral interventions to help her cope with the increased stress related to schoolwork and after-school activities.

Although Leah was eager to resume exercise and team activities, Dr. DiFazio cautioned against too rapid a return to contact. “Increasingly progressive, strenuous activity is recommended for athletes,” he says. “We took our time to ensure full recovery and finally, I cleared Leah for play.”

That clearance, along with concussion education for youth coaches, parents and students, became Maryland law in July (Education— Public Schools and Youth Sports Programs— Concussions, Education, Section 7-432, and Health—General, Section 14-501, Annotated Code of Maryland).

This is critical, Dr. DiFazio says, because second and third concussions typically exacerbate the initial symptoms and could result in rare but deadly brain swelling known as second impact syndrome.

Local Safety Measures

“Acute signs of a concussion may not appear for hours or even days.” —Marc DiFazio, M.D.

“Acute signs of a concussion may not appear for hours or even days.” —Marc DiFazio, M.D.

Montgomery County Public Schools have long practiced such sports safety policies. Similar to the state law, “Montgomery County Public Schools have a concussion program that addresses four components: education, recognition of concussion, responsibility—who determines the injury—and procedures on when a student can return to practice or play,” says Duke Beattie, the county’s director of school systemwide athletics. Specifically, Beattie adds, coaches must take annual courses on sports and concussions and how to prevent and care for athletic injuries. Likewise, parents and students are informed about the risks and symptoms of head injuries.

The school system also offers student-athletes baseline testing, which measures normal brain function and activity. The testing is something the entire Hunsinger family strongly encourages. The day after the injury, Quince Orchard’s athletic trainer performed the follow-up test that helped establish the severity of Leah’s concussion.

Leah has fully recovered and the recent graduate is preparing to play field hockey for York College in Pennsylvania this fall. Dr. DiFazio is a proponent of her decision to remain active.

“Balance must be struck,” he says, “between reducing the risk of concussion and encouraging participation in sports to ensure cardiovascular fitness and develop life skills through team and individual play.”