48HR Film Festival

Team Cool (Ara Jay Rice, Johnny Martinez, JT Atwood, Grace Brown, and Matt Alleyne) work on set shooting their short film Jan. 21st, 2023 at their apartment in Carbondale. “This year’s Festival has been a lot of fun, we’ve really enjoyed pushing ourselves,” Rice said.

Ethan Grimm egrimm@dailyegyptian.com

“Even though the kids are educated, they might be educated so much that they know they’re gonna get pulled,” said Yates. “We have a new concussion at Herrin that got reported yesterday, but she got hit on Monday. She didn’t report it until Wednesday. She didn’t report it because she took a blow from a volleyball right before a sectional game. One, she wasn’t sure if she was really concussed, she was embarrassed that she got hit, she wanted to play and so she just went home after the game. The next day she went, ‘oh no big deal, I feel a little better’ but then, by Wednesday, she felt worse, probably because she went to school and tried to focus all day.”

SIU doctors, who cover several of the local highschools and collaborate with SIH, are no strangers to the concept of patients tricking medical practitioners.

“Yes, there are going to be some athletes that won’t tell you,” said Schonewolf. “You know, I think I just read a quote from Bart Scott, a former player here. He kind of scored low on his initial assessment [SIU students complete baseline concussion assessments so that their normal results can be compared to post impact results]. He failed it so he could score better when it was real so he could go back out and play.”

Aliling said he’s seen opposing teams attempt to put athletes back out to play after they’ve suffered head injuries that removed them from games or practices.

“When the patient gets concussed, there are several mandatory observable signs that we need to be able to elucidate,” Aliling said. “That patient, when he got hit, remained motionless for more than five seconds. He was staring a blank stare. And then when it came up, he’s very disorganized in terms of his balance, and then he was disoriented.”

This patient in particular also failed neurological tests asking him where he was and what he was doing, even though he reported no pain. The patient, one of the opposing team’s star players, wanted nothing more than to go out and continue to play, despite being clearly injured. Though he was taken out of play at Aliling’s recommendation, the debate still continued in the second half of the game.

“So I checked him out during halftime, he’s still a little bit disoriented, still kind of like having some neurologic deficit during that time, but he was improving and they were thinking of bringing him back to the second half,” Alilings said. “So I talked again to the other team’s athletic trainer, ‘You know, I’m not biased in any way because I’m currently working for the other team. I’m just here to kind of make sure everybody’s going to be safe and nobody gets injured. I have good intentions. So you know what, even though I’m the opposing team’s physician, I saw what happened in the field. And I think he really does have a concussion.’ So I think they were attempting to bring him back. But I said, ‘there’s no way that you can come back.’”

If the scenario had gone differently, a lack of medical professionals at the site of the game could have forever changed this athlete’s life. The effects of multiple concussions in short succession can range from increased recovery time to catastrophic brain injury or death, yet even a large and obvious injury nearly wasn’t enough to convince this team to keep their star player out of the game.

“This phenomenon is called the second hit phenomenon, wherein you have a concussion and you’re not completely healed and you pretty much go back to sports and get another concussion,” Aliling said. “The brain has not calibrated to where it was before. So it could cause a catastrophic, catastrophic event, which is kind of weird. It’s kind of like a swelling of the brain where injuries can occur - dysregulation in the blood flow into the brain. It causes cerebral edema and herniation. It could cause lots of disabilities. That’s why we need to do a thorough evaluation of athletes, making sure that when they go back they follow the return to play protocol and when they come back, they’re back to their baseline.”

Though most concussions are mild, suffering a second impact even without obvious concussion symptoms can result in a prolonged recovery time, or worsened injuries.

“I mean, it [the brain] will usually reset back to normal, but the biggest thing, when you look at advanced - and maybe you were gonna ask this question or not - CTE, chronic traumatic encephalopathy, whether it’s one big major concussion, or if it’s a lot of small things that the brain might not even realize a small brain injurysmall little hits - things build up,” Schonewolf said.

According to Schonewolf, everyone reacts differently to concussions. Children with developing brains often take longer to recover than adults. According to the University of Michigan Concussion Center, females take longer to recover than males. Even individuals are subject to great differences in recovery time and symptoms. Individuals that have received concussions before are even more predisposed to them in the future, suffering more symptoms from smaller impacts. Many concussions don’t even come from sports so much as everyday events.

What all concussions have in common are their bewildering effect on the brain. Concussions cause a flurry of activity in the brain, sending confused signals between the various centers of the brain and producing a mental fog as brain activity slows. Generally fatalities from concussions are caused by exessive blood flow to the brain as a result of this confusion of signals, but over long periods of time concussions begin to have an effect on the structure of the brain itself. This is called Chronic Traumatic Encephalopathy or CTE, something that’s only really detectable by postmortum autopsies of repeat concussion victims.

“Once you have CTE, it’s permanent. It’s a progressive deterioration in the neurologic status,” Aliling said. “So it affects your cognitive function and executive function, your memory, it alters your behavior. You lose impulse control, it is a form of impulsivity as well so you become impulsive. You have some mood disorders, you lose some cognitive function, especially memory. And then you also have alterations in sleep. So it’s a progressive deterioration. It is actually an accumulation of certain abnormal proteins, tau proteins that kind of developed in the brain. So what they think we’re University of Michigan is doing to kind of get a biomarker to detect tau proteins. Just a way to get it from the blood or from fluids in the body. It’s a technology still in development.”

Athlete’s attitudes towards football are often cultivated by coaches and teammates to inspire loyalty to the team and put great emphasis on winning. Turning a player’s engagement with the sport and loyalty to the team into a risk to their own health is unthinkable, but nonetheless a problem according to the CDC’s online training pamphlet on concussions.

The American Journal of Sports Medicine claims as many as 7 in 10 young athletes with a possible concussion report playing with concussion symptoms. Out of those, 4 in 10 said their coaches were unaware that they had a possible concussion.

Yates said that the big concussions are easy to notice, because students immediately display obvious symptoms like losing consciousness or experiencing seizures. The smaller concussions are tricky to notice, and yet dangerous to athletes due to the cumulative effects multiple untreated concussions can have on the brain.

This is why it’s concerning that coaches are sometimes the only group responsible for observing concussions at schools, due to the fact that coaches have many other things to worry about, including managing their teams strategy and keeping team morale up. Although they may be able to recognize some signs of concussions through their familiarity with their players, at the end of the day coaches aren’t able to diagnose concussions. The best they can do is watch for heavy hits in games and, even in that area, coaches are unlikely to match the level of attention that an athletic trainer or doctor with only one job can give to the heavy blows in the game.

Despite it all, Schonewolf said, as the atmosphere of today’s athletic world becomes more aware of the health implications of concussions, athletes are acknowledging the importance of concussion protocol more but also says that it depends on the place.

At SIU, Shonewolf says that players and coaches understand the risks of concussions well. According to the university’s official concussion protocol documents, every year each SIU student athlete is informed about concussions and required to sign a form saying acknowledging that they were educated.

High schools are supposed to have a designated employee at the school that oversees concussion management. Seven of the 10 schools couldn’t give a good answer when asked who that employee is. Most of the schools break up the oversight among three or four individuals. These individuals ranged from athletic trainers, athletic directors, school nurses, and head coaches. The remaining schools rely on professionals that are under contract with nearby hospitals, such as the SIH Carbondale Memorial Hospital.

A major positive for the local schools is the reporting of concussions to the IHSA. All 10 schools said that they report their concussions to the Illinois High School Association, the main body serving high school athletics within the state of Illinois. It oversees everything that pertains to high school athletes including concussions and other injuries, but seldom intervenes to alter high school programs. According to Yates, IHSA monitors the number of concussions reported by high schools, but mostly for research purposes. However, there are firm guidelines for treatment once athletes are confirmed to have concussions. Once an athlete has a concussion, they must follow certain guidelines in order to fully return to their schoolwork and their athletic pursuits. The first is “return to learn” and the second is “return to play”. “ That’s where it can get sort of murky. Each school is allowed to list its own versions of return to learn and return to play. They all have the same ideas, but different wording can lead to different interpretations. Out of 10 southern

Illinois schools that were surveyed, none of them had the same definitions of the return process for a concussed athlete. This is because Illinois law requires each school to come up with its own concussion protocol, rather than prescribing one state-wide protocol. While this could potentially result in further inequalities in the treatment quality given to athletes based on the staff and expertise at the school, concussion protocol across the entire country has made great advancements in the last couple of decades overall, and did not vary drastically across most of the local highschools.

“I’ve been here for 20 years, so when I started there were really no concussion protocols for the high schools,” Yates said. “You probably could talk to people my age who would say ‘well back in the day no one had concussions.’ Well, they probably did, they just didn’t know they had a concussion. Even when I started, if someone took a blow you didn’t even test them for 15 minutes. You let them sit and get their bearings. You didn’t test them because they weren’t accurate. Now we know that that’s not necessarily true. It’s gone from us being educated - as medical professionals even - at a conservative level to now we’ve got protocols for academics, protocols for return to play, protocols for vestibular and vision issues…It’s gone pretty far in the 20 years that I’ve worked. In the medical world that’s pretty impressive.”

Specifically, advancements have been made in the treatment of concussions, even if detection remains an issue.

“Where it used to be ‘they need to rest, they need to be checked every hour, don’t let them do anything, put them in a dark room’ to ‘well we need to have them doing some activity just no blows to the head, they need to start walking more they need to increase their heart rate to get some blood supply.’” Yates said.

Staff reporter can be reached at dbethers@ dailyegyptian.com