STEVE INSKEEP, host:
When a football player takes a hit that he didn't see coming, people say he's been earholed. The word comes from the hole in the side of the helmet. A year and a half ago, it happened to Billy Hagberg, a high school player in Pittsburgh.
Mr. BILLY HAGBERG (High School Football Player, Pittsburgh): I was on the ground. My face felt really - it felt like it was asleep, the pins and needles, tingling and everything.
INSKEEP: Which was just the beginning of an ordeal we're tracking in our series on sports concussions.
Here's NPR's Tom Goldman.
TOM GOLDMAN: Fourteen-year-old Billy Hagberg turned a somersault in midair and landed on the ground with a concussion. The jarring hit shook his brain inside the skull the way an egg yolk would move inside its shell. Hagberg didn't pass out. He got up and finished the play on the field. Then, feeling a bit dazed, he jogged to the sideline, where the team's athletic trainer had watched Hagberg go down.
Mr. HAGBERG: Yeah, the trainer came up and asked me if I was all right. And I just like, yeah, yeah, I'm fine. I'm fine. Don't worry about me.
GOLDMAN: Hagberg was a freshman linebacker playing on the varsity at Pittsburgh's Fox Chapel High School. It was a big deal, and the big hit left him feeling humiliated.
Mr. HAGBERG: I just don't want anyone to just sort of come up to me and like, oh, he got hurt now, too. I mean, I just don't want anything else piled on to the fact that I got embarrassed in front of the entire team.
GOLDMAN: So he shooed away the trainer and played the rest of the game with a headache. It continued through the night and got worse the next day when he played again in a junior varsity game. Near the end, Hagberg was dizzy and having trouble remembering plays. Afterwards, he said to his coach, I think I have a concussion.
Mr. HAGBERG: I told the coach what happened and he said, well, just tell the trainer on Monday. Just take it easy for the rest of the weekend.
GOLDMAN: Which seemed like good advice. Hagberg's dad, Bill, once was knocked unconscious in a high school football game. He threw up and had a headache for a couple of days, then he got better. He assumed his son would, too. That's what Bill, an orthopedic surgeon, told his physician wife Margaret, an OB/GYN.
Dr. MARGARET HAGBERG (OB/GYN, Pittsburgh): He didn't think it was a big deal. And neither of us really thought it was serious in any way.
GOLDMAN: But the family's pediatrician did, and advised Margaret to get help quickly. The Hagbergs went to the Sports Concussion Program at the University of Pittsburgh Medical Center. Assistant Director Dr. Mickey Collins examined Billy and performed a computerized test called an Impact Test. It measures things like reaction time, memory and the ability to scan visually. Dr. Collins diagnosed a severe concussion, severe because Billy kept playing after the initial brain injury.
Dr. MICKEY COLLINS (Assistant Director, University of Pittsburgh Medical Center): There's two things you don't want to do when you're recovering from a concussion: number one is take even minimal blows to the head, and number two is increase the metabolic activity in the brain. And going back to a JV football game, you're doing both of those things.
GOLDMAN: It took 10 months for Billy Hagberg to fully recover. The first few were hellish. He missed a lot of school - trying to concentrate in class put too much stress on his brain and increased the symptoms. At home, walking up and down stairs made him nauseous and dizzy and made his constant headache worse.
Mr. HAGBERG: I pretty much just slept and sat around. And every, like, 20 minutes, I'd try and pick up a book, read it, just throw it - couldn't do anything.
Dr. HAGBERG: It was as if there were some barrier between himself and myself, and that he couldn't really even understand the questions I was asking him. And that's really scary as a parent.
GOLDMAN: Billy Hagberg was lucky. His school, in a well-to-do part of Pittsburgh, had a certified athletic trainer for football games - not all states require them. And it was one of more than a thousand schools nationwide that has the Impact Test - a valuable objective tool for measuring concussions. Still, smart, well-meaning people made mistakes. Billy admits it started with him, right after he got earholed.
Mr. HAGBERG: I blame myself a little bit. I mean, I probably should just told the trainer what was up.
GOLDMAN: No one blamed the trainer, but a concussion expert says after seeing the violent hit, the trainer could have gone beyond, are you okay? - to determine if Billy had a concussion. The signs include headaches and sensitivity to light and noise. To assess mental status, a trainer could ask the athlete to list the days of the week backwards. And Margaret Hagberg regrets she and her husband didn't know more.
Dr. HAGBERG: All of our friends practically are physicians. And except for our pediatrician, nobody knew anything about concussions. It's just amazing that this information's out there, but nobody really is aware of it.
GOLDMAN: Including many coaches, teachers and doctors. Concussion experts are trying to get the word out. Dr. Collins co-wrote an informational toolkit the Centers for Disease Control is sending to doctors nationwide in May. It has the latest information on how to manage sports concussions in the critical early stages on the field and long-term. Collins wants to spread the word because the current estimate of between 1.4 million and 3.8 million youth sports concussions a year is going to grow, he says, with young athletes getting faster and bigger all the time.
(Soundbite of cheering, clapping)
GOLDMAN: Billy's now 16 years old. He was cleared to play football last August, and he and his teammates have been lifting weights this month as part of their spring workout. He says it wasn't hard making the decision to go back.
Mr. HAGBERG: I just really love the game way too much to just walk away. To be honest, it's going to take a lot more than a concussion to keep me off.
GOLDMAN: Billy says he's not worried, but anytime he has an injury, even if it seems small, he says he'll go straight to the medical staff. It's a crystal-clear lesson he learned in a foggy and frightening world.
Tom Goldman, NPR News.
INSKEEP: You can hear about concussions in professional football at npr.org.
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