State's concussions law has brought more attention, treatment, but recovery for student athletes can be difficult

January 29, 2016 11:00 pm • Last Updated: January 31, 2016 7:12 pm

Concussion patient Hillary Goldstein, 17, of Colchester uses a Brock string during a therapy session with Dr. Christine Semenza at Behavioral Optometry in Old Lyme Thursday, Jan. 21, 2016. (Dana Jensen/The Day)
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After school one day last week, while her classmates drilled with their sports teams or tackled their homework, Hillary Goldstein practiced how to see.

For the 17-year-old senior at The Williams School in New London, that meant catapulting beanbags off a plank and catching them.

Wearing oversized prism glasses, she walked backwards and forwards along a 2-by-4 while reading letters off a board.

She focused on strange, three-dimensional images called vectograms and followed colored balls along a string between her nose and a wall.

“You really learn about vision through your motor skills,” explained Dr. Christine Semenza, the Old Lyme behaviorial optometrist who’s been leading the Colchester teen through vision therapy exercises for the past year. “What you often see in concussion patients is trouble with (visual) convergence and balance, so I’m making things look closer and farther away for her so she has to adjust her eyes and balance.”

Two years ago, Goldstein suffered the first of four concussions in a freak head-on collision with another member of her high school swim team during practice at a local pool.

Three more accidents followed: She slammed her head on a car door; took a severe jolt when her mother’s car hit a deer, deploying the air bag; and had a stack of books fall from a high shelf on top of her at school.

Classic concussion symptoms — daylong headaches, forgetfulness, difficulty concentrating and double vision — plagued her.

Heightened sensitivity to light, noise and loud music forced her to curtail time on her computer and cell phone and turn down invitations to go bowling or to school dances.

Watching a movie with subtitles in Spanish class recently gave her a headache.

“It’s a lot of work trying to read. I can only read for five to 10 minutes, because focusing is so hard, so I use a lot of audiobooks,” said Goldstein. “Sitting for my SATs was really painful, even though I had extended time and could take breaks when I needed to. And watching football now just makes me cringe.”

With the Super Bowl game coming against the backdrop of the current movie “Concussion,” which recounts the troubling story of the prevalence of brain trauma in professional football and efforts to conceal it, the issue of sports-related concussions is attracting attention anew.

Over the past few years, awareness has grown about the dangers of concussions — a severe head blow in which the brain, normally floating in cerebrospinal fluid, is thrown against the skull.

Many states including Connecticut have enacted laws to ensure better identification and treatment for student athletes with concussions.

Cases like Goldstein’s, while unfortunate, do show that progress has been made, experts say.

They demonstrate how seriously this invisible injury, once minimized or ignored entirely, is being handled more effectively by coaches, parents, schools and the students themselves.

“In 10th grade I had to take a baseline test for the swim team, and I was like, ‘Why do I have to do this?’“ Goldstein recalled, referring to the online cognitive test schools now give routinely to student athletes at the beginning of a season.

The test is given again after a suspected concussion, and the results compared.

Now, she said, she appreciates the baseline tests and the accommodations her teachers have afforded her on exams and homework assignments.

Her new appreciation for what it takes to recover from a concussion, she said, has given her valuable first-hand insight she will draw on as she begins next fall at Skidmore College, where she plans to study to become a special education teacher.

“All my teachers have been great, and my friends have been very helpful,” she said.

A few years ago, that might not have been the case.

Dr. William Horgan, medical director of the Emergency Department at The William W. Backus Hospital in Norwich, said laws passed in Connecticut in 2010, then strengthened in 2012 and 2014, have been effective in making schools, coaches, parents and student athletes more willing to report possible concussions and ensure they’re treated properly.

The law requires annual concussion training for coaches and students.

Parents of athletes have to sign consent forms verifying that they’ve read concussion education materials provided by schools, and a written clearance from a physician is required before concussion victims can return to their sport, among other steps.

School boards are now required to adopt concussion education and prevention plans, and this year for the first time must submit a report on the number of concussions among student athletes to the state Department of Public Health.

“The law has done a lot, because it’s put an emphasis on schools and sports organizations to pay attention to this and to get training,” said Horgan, who also coaches youth soccer in Stonington.

The pre- and post-concussion cognitive assessment, he believes, is one of the most valuable tools now being used.

“Coaches are taking this to heart and putting the child first,” he said. “It’s improved dramatically.”

Nina Beebe of East Lyme, whose son Dean suffered four concussions when he played for the high school football team, said that was true for her family.

“The coach was wonderful,” she recalled. “He (her son) wasn’t rushed to get back out on the field, even though he was the captain and he really wanted to be back out there.”

In the emergency room, Horgan said, he typically treats two to three student athletes per week with concussions. While the injuries can come in any sport, football is the most frequent, he said.

“About 20 percent of high school football players will get a concussion,” he said, noting national statistics showing there are 1.75 million sports-related concussions annually.

Despite greater awareness, he said, he still encounters misconceptions. The most common one, he said, is that if an athlete didn’t lose consciousness, the concussion wasn’t severe.

“That’s not true,” he said. “Passing out is not a great predictor of how well you will do or how well you will recuperate.”

While student athletes are more willing to self-report when they have concussion symptoms, Horgan said, many have difficulty sticking with the doctor’s instructions for recovery, which can take anywhere from five days to two weeks or more, especially if it’s a repeat injury. Parental supervision is key, he said.

“They have to give their brains a rest. That means no intensive reading, no use of video games or smart phones,” he said. “They need to shut themselves down.”

For many student athletes, being away from teammates and allowed only limited communication through social media is very challenging.

“All their social ties are related to sports, and they feel their entire sports career is tied up,” he said.

Dean Beebe, now a 19-year-old student at Nichols College, agreed that the recovery regimen was his biggest struggle.

Besides the four concussions in high school football, he suffered a fifth during a snowboarding accident during his freshman year of college.

Even though he was wearing a helmet, he said, that injury was the worst of all, perhaps because his brain had already endured so many jolts.

After that injury, he said, he returned to his college football team briefly. But after one more concussion on the field — his sixth — he quit football altogether.

“The number one thing for me was my head being safe,” he said. “I realized I wasn’t going to be playing football for the rest of my life. Now, I don’t even know if I would ever let my kids play football.”

Quitting, he said, forced him to leave the daily interactions with his closest friends on the team, and to find new ways to exercise.

“Football was my life, my passion,” said Beebe, who is majoring in management and communications. “One of the hardest things I had to go through was walking away from it.”

Steve Hargis, athletic director for East Lyme schools, said that while the Connecticut concussion laws have given coaches and athletic trainers the tools they need to keep students off the field after a head injury, they can still encounter resistance from students and parents.

There are about five to eight concussions per year among athletes in the various sports teams in East Lyme schools, he said.

“The toughest part is the parents who want to challenge us. They want their kids back on the field,” he said.

“That’s why we rely on our impact program,” he added, referring to the cognitive testing done for all student athletes.

Bryan Morrone, Stonington athletic director, has encountered both parents who are impatient to get their son or daughter back to their game and those who are quick to assume that every hard hit results in a concussion.

“You have parents who are overly cautious and parents who played football back in the day and always played no matter what,” he said. “At the very least, if a coach suspects a student had a concussion, the student sits out for the rest of the game. But we still have kids who want to rush back because of a rivalry game. We try to promote that having them sit out for five or six days is for their future.”

One way to help athletes recovering from concussions cope better with being away from their social network, he said, is to have them participate in non-contact drills or do stationary biking or other exercises with the team until they’re ready to rejoin the team entirely.

While much has improved in the recognition and treatment of concussions, physicians like Dr. Oliver Mayorga, chairman of the Emergency Department of Lawrence + Memorial Hospital in New London, said there is not yet full acceptance about the seriousness of head trauma injuries or how easily they can occur.

“The laws have legitimized it,” he said. “But we still have students who are completely crestfallen when they’re diagnosed with a concussion and have to miss a game. And there are players who think that helmets are safer now, so they can be more aggressive. They have a false sense of security that because of the helmets, they’re not going to be diagnosed with a concussion.”

Another important message, according to New London neurosurgeon Dr. Patrick Doherty, is that after the first concussion, the brain takes longer to heal.

“People still underestimate the effects of a second concussion,” he said. “The brain recovers less easily because it’s already damaged. It sets you back further in your ability to concentrate and focus and in your attention span. Organizational skills and eye coordination can suffer.”

Minimizing stimulation and “giving the brain some slack” to heal are key, he said.

For Goldstein, that’s meant taking up drawing and coloring to relax instead of going on Facebook, taking frequent breaks when she’s doing homework, and accepting that she may not be as strong academically as she once was.

“My teachers had to tell me quite a lot that it was OK if I didn’t get 90s on my quizzes all the time,” she said. “I’m more aware about it and I’m learning my limits.”

j.benson@theday.com

Twitter: @BensonJudy

Concussions among Connecticut public school students, 2014-2015 school year:

5,551 (139 districts reporting)

Concussions outside of school: 2,436

Concussions during interscholastic athletics: 1,820

Concussions during physical education class: 387

Concussions during school recess: 267

Source: state Department of Public Health

Concussion symptoms can include:

difficulty thinking clearly

headache