Jumping for a rebound, forward Allie Zisko collided with another player and landed hard on her head during an eighth-grade parochial school basketball game.
Alie Zisko and her father, Dr. John Zisko.
Because she exhibited symptoms of concussion, Allie's family took her home for rest. The next day, she didn't know her brother's name. But after a few more days, she appeared to be much better, said her father, Dr. John Zisko.
Zisko had Allie take a computer-based cognitive test to verify her progress in recovery. The results showed split-second delays in simple mental processing, showing that she still was injured.
"This is a very useful tool for individual treatment. She looked like a million bucks, but the test picked up subtle problems," he said of the injury in March 2013.
As a team doctor for a high school, and a sports medicine specialist for Wellington Orthopaedic & Sports Medicine, a partner of Mercy Health in Cincinnati, Zisko has treated plenty of groggy kids after they stumbled out of football, soccer and basketball games.
Setting the baseline
The test he gave his daughter is known as ImPACT (Immediate Post-Concussion Assessment and Cognitive Testing), produced by a company in Pittsburgh. Zisko and his associates use it in their work in sports medicine at Mercy Health, which serves the sports programs of 28 high schools in southwestern Ohio and northern Kentucky.
Mercy Health's work in that arena took on added importance last year with enactment of a new Ohio law requiring that young athletes be removed from games if they exhibit symptoms of concussion, a jarring soft-tissue brain injury that can impair mental function. Injured players can't return to practice or future games until a doctor's examination clears them for play. The law applies to youths who participate in organized contact sports through their schools or private leagues.
Mercy Health is working to have all high school athletes in its service network who play contact sports, including wrestling and field hockey, take the ImPACT test every two years to provide a baseline for future testing as needed, Zisko said. In December, the Cincinnati Bengals professional football team gave Mercy Health $5,000 to complete that baseline inventory.
Dr. Dan Roth, Mercy Health's chief medical officer, said the Bengals' gift will help complete the baseline testing for roughly 5,000 student athletes. Roth said the work will "ensure that they don't return to sports before they're fully healed."
If an athlete suffers a head injury, he or she must take the same test again, which can reveal the sorts of "subtle changes" that Zisko recognized through the test taken by his own daughter. In the Mercy Health program, injured student athletes must pass the base standards of the test before they are cleared to return to sports.
Time-out
Allie, now 15, stayed home from school for a week after her concussion. She was able to return to sports after three weeks. She now is a freshman at Saint Ursula Academy in Cincinnati.
Zisko said the testing is important because only about 40 percent of youths who suffer concussion are fully recovered within a week. Twenty percent still aren't recovered after three weeks. An athlete who suffers a concussion is three to five times more likely to suffer another one, he said.
Zisko said the effects of concussion sometimes are at their worst 24 to 48 hours after injury, making it even more important for coaches and trainers to take initial symptoms seriously. He praised the new Ohio law for mandating that caution.
The federal Centers for Disease Control and Prevention says multiple concussions can lead to permanent brain injury, including increased risk for Alzheimer's and Parkinson's diseases. Generally, rest — both physical and mental — is recommended for people who suffer concussions. The CDC says activities that require mental concentration, such as studying and playing video games, can hinder recovery.
Football's risk
A National Collegiate Athletic Association study of concussions among college athletes showed that football is the most dangerous of the major sports, with 3.1 concussions among players per 1,000 practices or games. The study, covering 2004 to 2009, also reported that female basketball players suffered 1.2 concussions per 1,000 events, or twice what the male players suffered.
Concussive injury also has been an increasingly sensitive subject for the National Football League, which began collecting data in 1996. In August, the NFL agreed to pay $765 million to settle the claims of more than 5,000 former players who reported head injuries from their playing years. The league also agreed to fund research on concussions.
But on Jan. 15, a federal judge in Philadelphia rejected the proposal, saying it didn't cover enough former players or provide enough money.
Heightened awareness
Zisko is the physician for sports teams at William Henry Harrison High School (the Wildcats) in Harrison, Ohio, northwest of Cincinnati. He said parents and school administrators have become more concerned about concussions in recent years. He called that a great improvement over practices that were common when he played football and baseball for Padua Franciscan High School in Parma, Ohio, near Cleveland, three decades ago.
"We have developed much more awareness of concussions, and of the likelihood of repetitive injury," he said.
At Harrison, Zisko works closely with head football coach Kent McCullough, who played football in the late 1990s at Miami University of Ohio. McCullough said attitudes are changing for the good of the players.
"It used to be that, if you got your bell rung out there on the field, you just kept playing," said McCullough. "The old-school mentality — that it's just the coach's decision to put a kid back in — is being eliminated. These are our children, and we're responsible for taking care of them. Everyone is more aware of the dangers."
McCullough said one of his players, a competitive youth who is a running back and linebacker, suffered a concussion from a hit during a kickoff return last season. How the team handled his case shows the change.
The boy came out of the game, as law required. After a few days, he appeared much better. He was agile and didn't have a headache. But the results of his ImPACT test follow-ups showed minor changes in reaction time that justified keeping him out of the next week's practices and game, McCullough said.
"He's a tough kid. Twenty years ago, he would have been back on the field for the next game," he said. "Giving him extra time off was the best decision for him."
Split-second indicators
Zisko said Mercy Health trains coaches and athletic trainers in the best ways to administer the 30-question computer test to ensure that the students take it seriously.
If a student athlete suffers a concussion, school trainers will have him or her take the test a day or so after the injury and retake it several days later. Zisko said that will give doctors clear indications of any changes in cognitive function, such as response time or answers to straightforward questions.
"That lets us consider cases individually rather than through national norms," he said. "The baseline gives us a snapshot in time. Retesting allows us to see changes in responses in fractions of seconds. We can better understand how much an injury affects that person."
Mercy Health maintains the test results. Athletes who seek follow-up treatment by its doctors are billed as regular patients.
Zisko said as many as 10 percent of student athletes in high-contact sports, such as football, suffer at least minor concussions each year. He said the testing is a big step forward in giving doctors data to determine when — and whether — it's safe for a student to play again.
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