The Other 60 Percent

A teen’s death prompts schools to improve concussion management

It was a hot August afternoon and football practice was just getting underway at Cherokee Trail High School in Aurora. Amid the gruff calls of assistant coaches and the smack of colliding shoulder pads came Coach Monte Thelen’s matter-of-fact voice at the end of each play, “Stay up, stay up, stay up!”

Football players at Cherokee Trail High School take part in a “thud” practice as an assistant coach looks on.

It was a half-pads “thud” practice and he wanted players to stay on their feet.

“We’re trying to limit the number of times players hit the ground with each other,” said Thelen. “We didn’t do that 10 years ago. I’m not even certain we did that eight years ago.”

This kind of safeguard is just one of many measures that has been employed over the last several years to help prevent an invisible and potentially life-threatening injury: concussions. In the Cherry Creek school district, where Cherokee Trail is located, the issue resonates with particular intensity because it is where Jake Snakenberg, a Grandview High School freshman, was playing football in 2004 when he took a routine hit and died of “Second Impact Syndrome” the next day.

Along with increasing awareness about concussions in the NFL and at the collegiate level, the 14-year-old’s death helped change the way youth concussions are handled in Colorado, giving rise to the Jake Snakenberg Youth Concussion Act, which took effect Jan 1, 2012.

The death of an athlete may be the most frightening consequence of concussions, but memory problems, concentration problems and other temporary cognitive deficits are more common outcomes. So while coaches and other advocates of good concussion management certainly want to prevent lethal “second hits,” they also want to ensure that concussed students have an efficient recovery so they can function in the classroom.

“It’s not just about return to play. It’s not just about sports,” said Karen McAvoy, director of the four-year-old Center for Concussion at Rocky Mountain Hospital for Children “You cannot return to play until you have 100 percent returned to learn.”

While experts agree that “Jake’s Law” has improved concussion management practices, they say that the state’s school districts and even its doctors do not always approach concussion management in a uniform way.

In Colorado, there is no statewide database on the number of youth concussions, sports-related or otherwise. However, national studies suggest that high school athletes sustain an estimated 136,000-300,000 concussions per year and the numbers have steadily increased. A 2011 study in the American Journal of Sports Medicine found that concussion rates in high school athletics increased by 16 percent annually from the 1997-1998 school year to the 2007-2008 year. The same study found that the most concussions occurred in football, followed by girls soccer.

Concussion resources

Impact of Jake’s Law

Jake’s Law, which applies to students 11-18 in school, club or recreational sports, requires that students suspected of sustaining a concussion be removed immediately from practice or games. In addition, students must be cleared by a doctor or other health care provider before returning to play. Finally, the law requires coaches to take annual trainings on the signs of concussion.

McAvoy said the legislation also helped emphasize the medical side of the concussion equation. Prior to the legislation, families were under no legal obligation to get kids suspected of sustaining concussions during sports checked by a doctor, and some chose not to, she said. With its return-to-play medical clearance provision, the law changed that.

“Through all of this the thread that you see is the culture change,” said McAvoy, who was a school psychologist at Grandview High School when Snakenberg died.

McAvoy said districts like Cherry Creek, Jeffco and Dougco have been at the forefront when it comes to developing effective concussion management programs.

Dr. Danny Mistry, chair of the Concussion Task Force in Grand Junction, said that despite a dramatic increase in awareness because of Snakenberg’s death and his namesake law, youth concussion management practices vary widely around Colorado. Although there are exceptions, he said, the east side of the state is generally ahead of the west side.

“It varies because of resources and education,” said Mistry, who practices at Western Orthopedics and Sports Medicine in Grand Junction, and who is a primary care team physician for Colorado Mesa University and the Colorado Rockies, as well as a team physician for USA Swimming.

In communities where concussion management is lagging, it may be due to both health care providers and the school system.  For example, Mistry said, some doctors may not see many youth athletes and may not be aware of the latest protocol for concussion management. In addition, school districts often can’t afford widespread staff training on concussions.

Like others experts, Mistry and McAvoy emphasize that student concussions must be managed by a team including athletic staff, parents, health care providers and teachers, who can often provide critical feedback about how a concussed student is functioning in the classroom.

Mistry said he hopes the National Institutes of Health or state departments of education will eventually set aside money to educate schools on concussion management.

“We’re in the midst of an epidemic and we have to stem the tide,” he said.

Tools of the trade

Talk to high school coaches and athletic directors around the state and you’ll hear about a variety of tools in place for concussion prevention, identification and management. Often, they’ll note that changes were underway even before Jake’s Law took effect — they saw the direction the pendulum was swinging.

That swing may have started in 2009, when Washington passed the first in a flurry of state statutes on the issue, the Zackery Lystedt Youth Concussion Bill. Today, the District of Columbia and every state except Mississippi have some sort of youth concussion law.

In Colorado, concussion prevention and education efforts include switching to lower-contact drills, reducing the weekly number of full-contact drills, experimenting with protective equipment such as the “Guardian Caps” that fit over football helmets, giving coaches pocket-sized cards listing concussion symptoms and having players and their parents read and sign concussion information sheets.

The free REAP Project booklet from the Rocky Mountain Hospital for Children is used widely in Colorado. It has also been used in New York and Florida.

Many school districts also use a highly-regarded concussion management protocol written by McAvoy called REAP, which stands for Reduce, Educate, Accommodate, Pace. Contained in a colorful 11-page booklet available for free from Rocky Mountain Hospital for Children, the protocol emphasizes the team approach, the careful monitoring of physical, emotional and cognitive symptoms, and a graduated “return-to-play” that allows student athletes to ramp up physical activity over the course of several days.

As recommended in REAP, districts have increasingly addressed cognitive symptoms of concussions, such as mental fatigue and difficulty concentrating, by making accommodations in the classroom such as reduced note-taking or extra time on tests.

Mark Kanagy, assistant principal of Windsor High School and athletic director in Weld RE-4 School District, said this is true in his district. In some cases, the district has put in place a temporary 504 plan, which are normally used to accommodate students with disabilities, for a concussed student.

Some Colorado districts also use a computer-based test called ImPACT, which measure students’ neurocognitive function at a baseline level as sports seasons begin, and can be administered after a suspected concussion to help determine whether new deficits exist.

While experts caution that ImPACT tests aren’t foolproof, they say they can be one piece of the puzzle in determining whether students are affected by concussion. The test is used at about 100 Colorado middle and high schools, according to company officials.

Paul Cain, athletic director for Mesa County District 51, said his district pays about $1,000 a year to use ImPACT for students in football, soccer, lacrosse, basketball, baseball, softball, diving, and cheerleading, as well as for students in other sports whose parents have requested it.

Kanagy, assistant principal of Windsor High School and athletic director in Weld RE-4 School District, said ImPACT “makes things more quantifiable…It helps take some of the guesswork out of it.”

He said a student might feel fine and have no headaches or other symptoms after a concussion, but if the post-injury ImPACT test doesn’t align with the baseline test, it can indicate something is still wrong.

Still, not everyone thinks ImPACT is an ideal tool. They say that students packed in a computer lab taking the test may not earn reliable baseline scores because they are distracted or deliberately performing poorly. In addition, not all doctors know how to interpret the test.

McAvoy said most school districts never use ImPACT because of its cost. “And that’s okay,” he said. “ImPACT is not necessarily where I would put limited resources.”

Trickle down effect

As standards for concussion education and management among youth athletes have risen, advocates say non-sports concussions in youth are starting to get more notice as well. Those concussions may result from a car accident, a fall or a bicycle crash outside of school, which means school staff don’t always know about them right away, if at all.

The REAP Project booklet is dedicated to Jake Snakenberg, who died of “Second Impact Syndrome” in 2004.

“Our biggest issue is getting non-athletic concussions communicated to our schools,” said Cain. “As a community that’s the next thing we need to work on.”

It’s not unusual for non-athletic concussions to outnumber sports-related ones. During the 2011-12 school year, about 60 percent of 200 student concussions in District 51 were not sports related, said Mistry. At Cherokee Trail High School, there were 25 non-athletic concussions last year compared to 15 sports-related.

“Really it comes down to the responsibility of the parent, the responsibility of the child,” said Steve Carpenter, athletic director at Cherokee Trail.

While some families inform the school nurse about out-of-school head injuries and, in Cherry Creek district staff receive training on recognizing non-athletic concussions, Carpenter said, “Those are tricky ones.”

McAvoy said while Jake’s Law exclusively addresses sports concussions in 11-18 year olds, concussion guidelines she co-wrote for the Colorado Department of Education, also address concussions sustained outside of sports and in students under 11.

Still, since parents aren’t required to seek medical advice for non-athletic concussions, it can be hard for school staff to know how to proceed, she said.

“When does a school feel comfortable releasing them back to recess, physical education and those kinds of things?”

after parkland

‘We’re not kidding about this,’ says one teen leader of Memphis march on gun violence

PHOTO: Dylan Peers McCoy
Students in Indianapolis participate in the National School Walkout on March 14. This Saturday, students in the Memphis area will join a related March for Our Lives.

Memphis students were on spring break when this month’s national school walkout against gun violence happened, but 13-year-old Simran Bains is not going to miss her chance to publicly speak her mind.

PHOTO: Simran Bains
Eighth-grader Simran Bains is a student leader at Schilling Farms Middle School in Collierville.

An eighth-grader at Schilling Farms Middle School in Collierville, which is on the outskirts of Memphis, Simran is one of more than a dozen teenagers planning this Saturday’s March for Our Lives in Memphis.

She believes the student drive to protest gun violence following last month’s shooting of 17 people in Parkland, Florida, will not end anytime soon. Saturday’s march is part of a national movement organized by Parkland students to keep the conversation going about gun violence.

“I think this moment is different,” Simran said. “For every school shooting I can remember, it’s the same cycle. People are sad and shocked, but nothing ever changes.”

Students and other supporters will walk to the National Civil Rights Museum from Clayborn Temple, the historic assembling area for civil rights marches of the 1960s.

We spoke with Simran about what this march means to her and what she hopes Memphis learns from it. (This interview has been lightly edited for clarity and length.)

Why are you participating in Saturday’s march?

For me, I’ve always been a little louder than my peers. I’ve always been one to go on a tangent or two. When I heard about the march from a friend, it really stood out to me because it’s being organized by people my age. I have never seen people this young doing stuff like this. It was inspiring. There’s this perception in society that there’s a gun problem in America and that’s how the world will always be. But here, I’m seeing young people, who are the future of America, changing the world, and I wanted to be a part of that.

What message do you hope to send?

I hope people hear that even though we’re young, we’re not kidding about this, and we won’t back down. I want people in Shelby County to care more about this issue and listen to us. I hope people recognize that even if they have a right to protection, no one should have to fear for their life while receiving a public education. This is a serious issue. If we don’t do something, it only gets worse from here.

But I also hope we can broaden the conversation beyond school shootings. We have one of the highest gun homicide rates in the world, one of the highest suicide-by-gun rates in the world. We’re talking about people killing themselves, not just people killing people. Suicide and homicide aren’t often brought into this conversation. I hope that changes in Memphis.

I also want the march to remind us that we can’t become desensitized to gun violence. Whenever we read that someone was shot, we don’t always think how somebody just lost one of their own. That person will have to go home to empty bedrooms.

What specifically would you like to see happen in Tennessee?

I’m personally not one to advocate for the total removal of guns. I think that’s sometimes an assumption of people who are against protests like March for Our Lives. They assume we want to take all guns away. That’s not necessarily true. But I want a written exam to purchase a gun, like in Japan. I also want a longer wait time when you purchase a gun. I don’t think you should be able to walk into a gun shop and walk out the same day with a weapon. School shootings, or gun violence in general, can often be a spur-of-the-moment decision. What if the person had to wait a few days, weeks or months before they actually got that gun? Would they still feel the same way they did when they first went to buy the gun?

Have you or your family or your friends ever been personally touched by gun violence?

My family has never been a gun family. My parents are immigrants from India, and it’s just never been a thing for us. Going to school where I do, there’s a lot of political viewpoints. Some people are really pro owning guns, some are really against. And it’s an interesting place to talk about this. But also, I’ve gotten to know people from different backgrounds. I know people in Memphis and areas surrounding it who have lost someone to guns. I’ve known people who have lost loved ones to guns in homicides or gang violence.

Starting young

These 11-year-old Brooklyn students are asking New York City to do something about segregated schools

PHOTO: Christina Veiga
Matilda and Eliza Seki, left, and their friends Noa and Benji Weiss, right, collected signatures at a district 15 meeting to discuss middle school integration efforts.

While they learned about the history of segregation, a group of Brooklyn 11-year-olds took a good look around their classrooms and realized their schools weren’t so different from the photos in their textbooks.

So Matilda and Eliza Seki paired up with their friends Noa and Benji Weiss — two sets of twins — and decided to do something about it. They launched a petition on calling on the city to integrate its schools.

“We learned about separate and equal in the civil rights movement, and that it was not equal,” Eliza said, referring to the “separate but equal” legal doctrine once used to justify segregation. “And since there are schools with people of only one race, and it’s all separated, it cannot be equal.”

Matilda and Eliza are in the sixth grade at M.S. 839, and Noa and Benji are fifth-graders at P.S. 10. They already have a bit of experience in activism, having joined the Women’s March in D.C., and helping to lead environmental clubs at their school. They hold sophisticated views for kids their age, and are aware of the hurdles ingrained in addressing school segregation.

Describing how housing patterns can tie into school quality, Benji began his thoughts by saying: “Let’s say you’re from a different culture or race and you don’t have as much money as other people do — because we still live in a racist country — and you’re in an area where the housing is cheaper but you don’t have as good schools.”

Across New York City, adults have debated how to spur integration in the country’s largest school system — and one of the most segregated. According to one recent analysis, the city’s most selective high schools enroll 84 percent white and Asian students, even though those groups make up only 30 percent of the city’s student enrollment.

But student-organized groups have also been at the forefront of a grassroots movement for more diverse schools. The work of budding advocates Matilda, Eliza, Noa and Benji caught the attention of some those groups, and they’ve now joined the ranks of Teens Take Charge and IntegrateNYC as some of the youngest members. The changes they’d like to see go beyond admissions policies, but also include a push for additional resources for underserved schools, hiring more teachers of color and curricula that reflects all students and cultures.

“We decided it was an important issue and we wanted to help fix it,” Noa said.

Matilda added: “Our schools should look like our city.”

Their schools are in District 15, where 81 percent of white students are concentrated in just three of the district’s most selective middle schools, according to an analysis by parents. The city has launched a series of public workshops to craft a new admissions model to integrate middle schools there, but these kids already have their own ideas for how to do that.

Benji, who is heading to middle school next year, said it would be “pretty good” if schools stopped picking students based on criteria such as class grades and attendance. Such “screening” contributes to segregation because of a number of factors — from which elementary schools students attend, to their parents’ ability to navigate the complicated admissions process.  

“It’s… important to learn about different peoples’ backgrounds, and religions, and cultures,” he said. “And also to make sure that all kids, no matter their race, religion or where they live can get the same, good education.”