According to the Centers for Disease Control and Prevention (CDC), there were approximately 214,110 TBI (traumatic brain injury) related hospitalizations in 2020 and 69,473 TBI-related deaths in 2021.
The most vulnerable age to sustain a concussion is between ages 9-22.
Males are nearly two times more likely to be hospitalized and three times more likely to die from a TBI than females.
A mild TBI, commonly known as a concussion, is a relatively common occurrence for these demographics.
During a concussion, the jello-like brain is shaken and bounces around inside the skull. When the brain jostles around, it stretches the connective tissue inside, creating an imbalance in the nerve cells and sending the brain into an energy crisis.
Experiencing a concussion can be concerning for both the victim and the people watching.
The symptoms can be just as frightening. Losing consciousness. Disorientation. Brain fog. Unfocused eyes. Slowed reactions. Slurred speech.
These symptoms vary between people and can’t determine the severity of the concussion alone.
“The saying in the field is that if you’ve seen one concussion, you’ve seen one concussion, because no two are identical,” UTSouthwestern Clinical Neuropsychologist C. Munro Cullum said.
If treated correctly and quickly, concussions have little to no long-term effects, as only 10 percent of concussion patients experience symptoms 30 days after impact.
However, if neglected and unchecked, they can permanently alter the brain’s working capabilities.
At a 12-year school like this one, concussions are inevitable. All boys. Ages 6-18. Various places for physical activity. Pent-up energy of kids. A wide variety of contact sports. Brains not fully developed.
The possibility of a blow to the head is endless, almost inevitable.
However, for over a decade, faculty such as nurse Julie Doerge, head athletic trainer Matt Hjertstedt, strength and conditioning coach Kevin Dilworth and Dr. James Carl Sterling have been working continuously to improve the concussion rates at St. Mark’s.
Before the school’s concussion protocol was introduced, there was little to no awareness or precaution regarding concussions.
“At that point, somebody could, if they weren’t knocked unconscious, go back in the game. The protocol was, ‘How many fingers am I holding up?’” Hjertstedt said.
Even in the academic world, before the program, concussed students would go to class as if they were healed, then fail their tests and, in turn, tank their grades.
As national awareness for concussions escalated, the faculty realized that a new form of precaution was needed.
“I think there was a culture change within athletics,” Hjertstedt said. “There were a lot of rule changes, but also the techniques changed. When I started here, you tackled someone by putting your head into the person’s belly. Now, you put your head off to the side, wrap up and alligator roll.”
This culture change is not only seen in football.
For example, lacrosse has become more of a finesse sport as opposed to a pure contact sport.
Additionally, wrestling has reserved times during matches to inspect injuries and determine if someone sustained a concussion or not.
The school’s protocol allows the trainers and nurses to work together to help each individual student recover as efficiently and effectively as possible. The protocol focuses on the patient seeking medical attention from a physician following at least 24 hours of rest.
Failing to seek medical attention is often a mistake made by people who experience a blow to the head.
“There’s several million concussions a year that are reported, and we think there’s probably twice that occurring where they’re not getting reported into record reporting systems, ” Cullum said. “A lot of people don’t even realize they’ve had a concussion. They say, ‘My head hurts. I see stars. I feel dizzy. But it’s no big deal. I’ll just go home and go to bed or whatever.’”
In addition to new technologies such as the imPACT test, the protocol also relies heavily on daily communication and honesty between the faculty and the patient, which is commonly a problem in concussion recovery.
“A number of studies have suggested that girls may report more symptoms,” Cullum said. “Now, are they really experiencing more symptoms, or are they more willing to admit the symptoms than adolescent males? Men tend to feel invincible to the world and don’t want to admit it, saying ‘Oh, I’m fine. I’m fine. I don’t have any symptoms’ even though they’re stumbling.”
Despite these challenges, the small, all-boys community of St. Mark’s supports the recovery process.
Not only do boys statistically recover faster than girls, but the all-boys community creates a more honest environment and the small student population allows for more individual care.
“I’m lucky because I’m here. I know most of the boys, so I know how they normally would respond,” Hjertstedt said.
Because of this mix of advantages, St. Mark’s recovery protocol is regarded as effective.
In addition, Dilworth has incorporated neck-strengthening into workouts, improving concussion rates across all sports.
In fact, only one-third of concussions across campus are from athletics, whereas the other two-thirds are from recreational play, most commonly during middle school free time.
Furthermore, only one concussion has occurred across all four St. Mark’s football teams this year.
Meanwhile, Junior Dylan Bosita is well-acquainted with concussions, having sustained one documented concussion along with various other blows to the head, all before middle school.
Slamming his face into a metal door frame: laceration between the eyes.
Smashing his face into a brick wall playing “imaginary” football: laceration in the same exact place between the eyes.
The wall was the endzone.
Hit in the head by the closing back door of an SUV.
Despite all these blows to the head, Bosita’s most impactful head injury was the most benign.
While in the lunch line, one of his fellow third-grade classmates jerked back in the line behind him, hitting Bosita’s head from behind.
Something was wrong.
Seeing stars, Bosita’s head throbbed in pain as he went to Doerge.
Following the protocol, Bosita was sent home and then saw a physician who diagnosed him with a concussion. The following two weeks were a struggle for Bosita.
Avoid sensory. No school. No sports. No phone. No video games. No direct sunlight.
“Imagine telling a third grader to sit in a dark room all day and not do anything,” Bosita said. “I wasn’t even allowed to listen to music.”
Bosita was restricted from doing many things, except for one: listening to the sports radio.
Bosita was lying in darkness when his dad found him sulking.
His dad told him that he was lucky because he could listen to all the MLB playoff games.
“I would sit and listen all day,” Bosita said. “When (my dad) came home from work, he would hang out with me and listen to Dodgers games, until they lost in the World Series to the Houston Astros… I really appreciate the opportunity I had to sit with my dad and talk about sports in a dark room.”
While following the Return to Learn policy that the concussion protocol requires, Bosita received immense amounts of support and help, readjusting to school and making up two weeks of assignments.
Although he was happy to be back, Bosita decided to make a difficult sacrifice due to his concussion: lacrosse.
“I really did enjoy the camaraderie with teammates and the opportunities to lay people out when they had the ball,” Bosita said. “Unfortunately, my family made the decision to stop collision sports, so I never played tackle football and I stopped playing lacrosse.”
According to Cullum, having multiple concussions, if treated correctly, has no correlation to the severity of long-term effects, if any at all.
Despite experiencing multiple concussion-like injuries, Bosita has seen no effects on his cognitive ability.
On the other hand, Senior Nolan Chu only needed one concussion to sustain certain losses of memory. Sophomore year. Fourth period.
He knows that it was the fourth period because all fire drills happen during then.
Physical Education. Football. Senior Sebastian Gonzalez was the quarterback. He remembers that.
Chu and another classmate jump up to fight for a reception.
Everything following that moment is erased from his memory, left with only his friends’ accounts to fill in the gaps.
“He slammed me to the ground,” Chu said. “I hit the back of my head on the ground. I got knocked out for like 15-20 seconds. (My friends) thought I was faking it because apparently I was snoring.”
Waking up dazed in the middle of the field, Chu sat up to see an empty field, except for P.E. Coach Trey Whitty standing beside him.
Aside from a slight headache, Chu felt normal, just a little disoriented.
While everyone else left for the fire drill, Chu stayed on the field as Trainer Matt Hjertstedt rushed to help him.
Chu followed the concussion procedure as expected.
Going home, resting, and seeing a physician where they gave him various eye tracking tests before slowly returning to school.
“They had a flashcard and I had to look back and forth between straightforward flashcards,” Chu said. “I felt that it was kind of unnecessary… I felt fine.”
When Chu returned to school, he could only attend class and didn’t take notes.
And with the end of the semester rapidly approaching and a week of make-up work, Chu’s return to school was stressful, ultimately causing his grades to drop.
“I think I went back a little too soon, honestly,” Chu said. “I still had a little bit of a headache. My mom said, ‘just go back to get back into it’… but I was there just sitting in class, not taking notes.”
Now a Senior, Chu has returned to normal.
But even today, the moments before and the months after his concussion are a blur.
He doesn’t clearly remember his eye-tracking tests.
He doesn’t clearly remember the events after he returned to consciousness.
The classes during his return to school are foggy.
Every time he tries to remember the football game, the memories come to him in spurts covered in a yellow tint.
Even though he feels normal, his friends have occasionally told him otherwise.
“I’d say I’m the same person, but other people have said that I’m not,” Chu said. “People brought it up a lot last year, saying, ‘Nolan (Chu) has CTE’ (Chronic Traumatic Encephalopathy), so I act differently. But I have no idea. Maybe people perceive me differently.”
Chu was relatively quiet during his freshman and sophomore year, eventually becoming more talkative over his junior and senior years.
Although his concussion happened amidst this change, he is unsure if the concussion was what caused it.
“I don’t know if I really changed inside,” Chu said. “I guess I felt more confident or something. I feel like something changed in my mind.”
The definition of CTE is a progressive neurodegenerative disease caused by repeated head impacts, typically sustained during contact sports or other activities involving repetitive brain trauma.
CTE is hard to diagnose and takes decades to determine its long-term effects.
Despite popular belief, most mental health problems that arise from concussions stem from anxiety.
“There is some anxiety about getting CTE. There’s some worry about developing depression,” Cullum said. “We think that it’s more people worrying and interpreting that, ‘Oh my gosh. I had those concussions 20 years ago. Now I’m worried about how my memory is going to be now that I’m in my 60s. A lot of it is just worrying. Most of those people look fine when we study them, and there’s not a lot of excessive depression, there’s not excessive anxiety.”