Sewickley teen’s recovery from concussion a long journey
Sharing the story of her recovery from a severe concussion with the teaching staff at her school was 17-year-old Madison MacDonald’s way of fulfilling her “personal project,” a junior-year requirement. The fact that she’s doing it as a senior is emblematic of the many things she’s had to put off since her everyday life as a teenager was put on hold for nearly two years.
Maddy, as she prefers to be called, ticked through an extensive list of things she could not do during many months of her recovery: “No television, no reading, no telephone, no computer, no crowds, no school, no physical activities. … The only thing I could do was listen to audio books, but mostly I just wanted to sleep.”
Her ordeal began in the winter of 2009 with extreme fatigue, random headaches, dizziness, blurred vision and trouble with balance and motion. She was experiencing the worst of concussion symptoms, yet the diagnosis was missed for months because Maddy could not recall hitting her head.
Poised and articulate, the Quaker Valley High School senior recalled the days before she was diagnosed with a severe concussion on Jan. 25, 2010, as some of the worst of her life. “My parents took me to the doctor’s in the beginning of January, because I was so sick — but they couldn’t find anything wrong with me.”
After weeks of being so sick she could not attend school — but with no diagnosis — her mother insisted she go back to class. Once there, Maddy was sent to the nurse’s office, where school nurse Aimee Benedict administered the ImPACT test and discovered Maddy was suffering from a severe concussion. She was immediately sent home, and her recovery began.
Defined as “a disturbance in brain function that occurs following either a blow to the head or as a result of the violent shaking of the head,” concussions have become especially prevalent among young athletes like Maddy, who was a member of her school’s soccer and basketball teams.
It is believed she sustained the initial trauma during soccer season and exacerbated the concussion by going right into basketball season.
“It wasn’t until I was halfway into basketball season that I realized there was something seriously wrong with me,” she recounted.” I couldn’t even walk straight down a hallway.”
Recognizing the inherent difficulties in concussion management, UPMC Center for Sports Medicine doctors Mark Lovell, who has a doctorate; Dr. Joseph Maroon, a physician; and Michael Collins, who also has a doctorate, co-founded ImPACT Applications Inc., headquartered in Pittsburgh.
ImPACT, which stands for Immediate Post-Concussion Assessment and Cognitive Testing, is a 20-minute, computerized battery of neuropsychological tests that measure attention and processing speeds in athletes with concussions.
Believed to be the first of its kind, ImPACT is now used by thousands of high schools, colleges, sports medicine centers and professional teams throughout the world and has become the best way for doctors to evaluate and manage concussions on an individual basis.
At Quaker Valley, as in many school districts, baseline ImPACT testing has become mandatory for high school students in most sports, including baseball, softball, basketball, lacrosse, soccer, diving, football, high jump/pole vault, hockey and volleyball.
Maddy’s mother, Amy MacDonald of Sewickley, said the diagnosis was a blessing. “She had become so sick; she just wasn’t herself at all. When she came home from school that day [after failing the ImPACT test], her whole attitude changed. She was relaxed, happier — as if a weight had been lifted.”
Being cut off from the rest of the world might seem like a jail sentence to most teens, but for Maddy, sleep was healing. “It was not hard for her to sleep,” recalled her mother. “She was so sick, that’s all she wanted to do, and she would sleep like an infant: All night long, most of the day, several naps, get up to eat and then back to sleep. Doctors’ appointments would exhaust her and give her headaches.
Mrs. McDonald said the school district was very helpful. With the exception of French, Maddy was able to complete coursework for 10th grade on time.
Mrs. MacDonald said she believes high schools should embrace the ImPACT test. “Because of that test, it was the one thing that supported her claim of being hurt. With proof that she was truly injured, then the school was able to help her.”
Mrs. Benedict has been the school nurse at Quaker Valley High School for three decades, but her training and experience in using ImPACT testing in the past four years has taught her that concussions sometimes happen when no one’s looking. “A concussion doesn’t have to be that one direct hit,” she explained. “It’s a repeated insult to the brain that then disrupts how the cells themselves function. … Our numbers [of student concussions] have increased each year since we’ve been using ImPACT, and last year we had 40 students with concussion.”
Mrs. Benedict said she attributes the increase not to more injuries, but to increased awareness. “The kids now know that they need to report their symptoms. We’ve seen that one big hit has severe symptoms, but Maddy’s symptoms were increasing in intensity.”
The annual incidence of sports-related concussion in this country is estimated at 300,000, but the chance of athletes who participate in contact sports experiencing a concussion may be close to 19 percent per season, according to the concussion program at UPMC Sports Medicine. An untreated concussion can lead to death.
“What we’ve learned about this injury over the past 10 years is amazing,” said Mr. Collins, assistant professor of Orthopedic Surgery and assistant director of the UPMC Sports Medicine Concussion Program. “This is not something you see on a CAT scan or MRI; it’s completely invisible to everyone, even parents. They can attribute it to teen lows or consider psychiatric problems; the symptoms can be so cryptic and nonspecific,” he said.
According to Mr. Collins, kids suffering from concussion shouldn’t be in school. “Concussion is a metabolic crisis, where the brain is starved for energy. During this time, you definitely don’t want to increase the demand for energy, and school is one of the most harmful things you can do, if it’s not being treated right.”
Teachers listening to Maddy questioned the validity of ImPACT test findings in cases of students who may simply be looking for a free pass to get out of school.
“I get questions from teachers about slackers all the time,” Mr. Collins acknowledged. “We have ways to determine that issue. The ImPACT test determines how severe the injury is and tells us what we need to do to fix it.”
Mr. Collins said he sees about 4,000 concussion cases a year in his offices in Bethel Park and in the Steelers Complex on the South Side. “Maddy’s story is played over to me hundreds of thousands of times. This is a lot more prevalent than one would think.”
Maddy’s reputation as a good student and motivated athlete lends credibility to her story, Mr. Collins said. For that reason, she stars in a research video with him about concussion recovery.
During her speech to the teachers, Maddy brought up the plight of the Penguin’s Sidney Crosby, now waiting for his concussion to heal before playing hockey again.
“I kind of know what he’s going through,” she said. Mr. Collins said ImPACT has been mandated in sports organizations such as the National Hockey League, Major League Baseball and the National Football League and is being used in multiple languages in different countries, but he’d like to see the test helping many more people.
“There’s a lot of effort to make this program accessible to a lot of kids,” he said, pointing out that Dick’s Sporting Goods recently pledged up to $1 million to pay for ImPACT testing of more than a million student athletes nationwide. Also, the Pittsburgh Penguins Foundation and UPMC Sports Medicine began sponsoring a program in May called Heads Up Pittsburgh, which will provide free, baseline concussion testing for local youth hockey players ages 11 to 18.
Some of Maddy’s teachers questioned the wisdom of participating in contact sports, because of the danger of concussion. Mrs. Benedict said concussion injuries are not confined to contact sports alone. “In each sport, they’re aware of the precautions they need to take, but it’s a side effect of being in sports. We see concussion spread out evenly among all of the sports — boys and girls — they’re pretty equal. It’s more a matter of us being able to recognize the initial symptoms.”
In July, Maddy’s ImPACT test scores were normal, she was taken off all medication and able to work all summer symptom-free. In August, she was cleared for limited drills with the soccer team, and she recently got her driver’s license.
“Missing school affect[ed] me today and pushed back my future plans, but good things have come out of this concussion,” she said. “It opened my eyes to the medical world, and now I want to go into psychology and neuroscience.”