Concussed: Changing the mindset in sports (Part 1 of 2)

Hermantown girls soccer coach Scott Larson noticed something amiss with Keely Lonetto soon after she was hit flush in the face by a soccer ball in a high school varsity game against Duluth Denfeld midway through the 2011 season.

Lonetto became dizzy and couldn't see straight, forcing Larson to pull his senior stopper off the field. On the sidelines, Lonetto felt nauseous and the team's trainer noticed her pupils were dilated, a tell-tale sign of one of the most talked-about subjects in the sports-health world.

"That's the new buzzword of the time: concussions," Larson said.

A trip to the Essentia Health St. Mary's Medical Center emergency room confirmed the diagnosis and started Lonetto down the road to experiencing firsthand Minnesota's new state law dealing with concussions.

That law, implemented Aug. 1, 2011, put into place a series of steps that concussed athletes must take in order to return to the playing field and kept the spotlight on an affliction that used to be brushed off in the sporting world as just "getting your bell rung."

"When people think concussion, it instantly conjures up a definition of something temporary that will go away and that it's not a big deal," said Richard Kanoff, a pediatric neurologist at Essentia Health who has practiced in Duluth for 17 years, "as opposed to using words like 'traumatic brain injury,' which when people hear they think about people in group homes with disabilities."

Lonetto's injury wasn't that severe, but she did miss three weeks of action and struggled academically when she returned to school. On her first day back at Hermantown, she was unable to give a PowerPoint presentation in her world history class because of an inability to concentrate.

"I was mad because obviously I know how to read and what my slide said, but I couldn't say it," she said. "It was so weird."

Lonetto's tale is one of many told by Northland athletes and highlights what health-care professionals have been saying for years about the dangers of not allowing the brain enough time to heal from a concussion.

"The truth is that concussions are a brain injury at the time that it occurs," Kanoff said. "If the event is significant enough, brain cells may be permanently lost."

In addition to the state law, the Minnesota State High School League also adopted the standard used by the National Federation of State High School Associations in dealing with concussions in all sports. The rule states:

"Any athlete who exhibits signs, symptoms or behaviors consistent with a concussion (such as loss of consciousness, headache, dizziness, confusion or balance problems) shall be immediately removed from the contest and shall not return to play until cleared by an appropriate health-care professional."

Head coaches were required to take an online course about looking out for signs of a concussion, which is what led Larson to pulling Lonetto off the field.

"It's not always going to be a huge collision, but sometimes (players) just take a header and then, all of a sudden, aren't paying attention," Larson said. "With Keely, it was a very minor collision and she ended up with a very major concussion. Had it not been for her behavior afterward, we would have never noticed.

"It's time for coaches to pay a lot more attention to it at the high school level."

Athletic trainers have taken concussions seriously for a long time and now find society catching up. In the past, coaches and players often were the most difficult to convince about the seriousness of the problem.

"Back in the day, when a kid said, 'I want to go back in,' you put them back in," Larson said. "That's the way it was when I played, but it's not that way anymore."

Changing that culture is the first step.

"You have to explain the risks to them that this could potentially cost them their life," said Bre Braun, an orthopedic athletic trainer at Essentia Health who was a trainer at Duluth Central when the school closed and has spent seven years on the sidelines. "You're not going to die because you play with an ankle sprain that hasn't quite healed. But if you go back with a concussion, it could kill you or you could end up as a vegetable the rest of your life.

"When you are dealing with kids, you have to give them that worst-case scenario or they don't understand it."

Multiple concussions plague Denfeld's Whiting

Graham Whiting's history with concussions goes back further than a one-time incident.

When the then-Duluth Denfeld senior was blindsided by a hit and slammed his head on the Public Schools Stadium turf during a 2011 football game against Moose Lake-Willow River, it marked the fourth time in four years that he suffered a concussion.

"I don't remember it, but my parents said I tried getting up a few times but couldn't," Whiting recalled recently. "I had to get helped off the field by the athletic trainer."

His mother, Jana, a physical therapist at In-Motion Therapy in Duluth, knew immediately that it was Graham's most serious concussion.

"Whenever you see somebody lying on the field without anybody around them and they aren't moving, you definitely worry," she said. "I think he was out for a few seconds because there was no movement in his entire body. He tried to get up, but he had spaghetti legs and couldn't support himself."

Whiting was bothered by blurred vision, a major headache, loss of memory and dizziness for the next few days. He sat out a week of practice and the next game, and, per the new rules, slowly worked his way through the exertion exercises with the team trainer.

Whiting earlier had suffered concussions playing football in eighth grade, basketball as a sophomore and again in football practice before his junior season.

The last time was the most traumatic.

"When I realized what happened, I got really scared," he said. "I wondered if something could be really wrong with my brain. I was super shocked and scared, but I did a good job with the rehabilitation, so that made me feel good."

Jana Whiting said she watched her son closely and kept him away from computers, phones and video games -- anything that wouldn't allow his brain time to rest and recover.

When he returned to the gridiron and took his first hit, Whiting says he felt a ringing in his head and the condition affected his play.

"I was definitely a lot more hesitant," he said. "My game wasn't on for the rest of the season because I was scared of getting another (concussion)."

After that injury, Whiting was advised to not play contact sports anymore. After receiving that advice and gleaning information from a report his older sister, Bri, wrote on concussions at the University of St. Thomas in St. Paul, Whiting decided to forgo football and compete in track and field and major in occupational therapy at St. Scholastica.

Baseline testing latest aid in concussion prevention

Lonetto benefited from the latest technological aid in learning more about concussions: baseline testing.

Prior to the 2011-12 school year, Essentia Health athletic trainers underwent training for Immediate Post-Concussion Assessment and Cognitive Testing. ImPACT testing provides athletes with a baseline in regard to recognition, memory, attention span and reaction time, among other categories.

"What it gives you is a baseline, neuro-cognitive level of where the kid is at," Braun said. "After the kid sustains a concussion, you have them retake the test and see if they are back to baseline or not."

Hermantown, Superior, Northwestern, Esko and Proctor implemented testing before last year's fall season, however the Duluth school district did not purchase ImPACT testing until the winter sports season. That meant Whiting did not have a baseline test on file until the basketball season.

Lonetto, who will play soccer at Wisconsin-Superior this fall, took the baseline test before her senior season and needed to retake it three times following her concussion. She was unable to even attempt the test the day after her injury because she couldn't look into the light or even read.

By the time Lonetto passed the exertion test and was cleared to play, she had missed three weeks and returned just one game before the playoffs.

Baseline testing is an encouraging aspect to MSHSL officials, who feel the law is working well in its initial stages.

"We were impressed with how smooth the transition went because we had to ensure every coach and every official had that training," associate director Kevin Merkle said. "Coaches seem to be more in tune and our officials are more in tune in making sure they keep their eyes open for concussions and getting those kids out of the game so they get evaluated.

"I'm not sure it's where we need to be yet. We still have too many coaches who are old-school, who think 'I played and had a concussion and it's not that big of a deal.' Hopefully, that's going to change as we move ahead."