Head injuries bring family ultimate loss
By Emily Young
Jack Foley sits at the kitchen table, a lit cigarette dangling from his pursed lips, and flips through a family album.
Running his thumb over an old, color photo in which he’s adjusting the strap of his 11-year-old son’s horseback riding helmet, he reflects on a life cut short.
The picture was taken on a brilliant fall day in 1991 — the same day Sean Foley suffered the first of several concussions that ultimately led to a deadly seizure in 2005.
“If they had known then what they know now about concussions, I’d have a bouncing grandchild about now,” says Jack Foley, a 70-year-old Derry, N.H., resident. “Parents can’t be too cautious. Because taking this it’s-only-a-concussion attitude is like suicide.”
Foley is right when he says medical experts know much more about concussions today than they did when Sean was alive. Research in the past five to 10 years has advanced quickly, and led to major strides in identifying and treating head injuries.
The learning curve continues, however, and meanwhile about 300,000 sports- and recreation-related traumatic brain injuries occur in the United States each year, according to statistics from the U.S. Centers for Disease Control and Prevention.
Concussion, bruising around the brain brought on by sudden movement, is dangerous enough. Second-impact syndrome — rapid swelling following yet another head injury — can be life-threatening.
The second impact itself may be slight. It only matters that the brain is jarred while symptoms of a concussion linger, said Dr. George Zitnay, a neuroscientist and brain surgeon.
“The recurrent effect, when symptoms haven’t cleared and the brain is re-injured, is far more devastating than if a previous concussion was cleared and brain function was back to normal,” said Dr. Mahlon Bradley, a Peabody orthopedic surgeon and president of High Performance Sports.
“That’s why it’s so important to know when an athlete is ready to be let back into play. In football and soccer, it’s really prevalent and older coaches need to learn more about making sideline decisions.”
Certainly, Sean Foley’s death is an extreme example of the potential perils of sustaining numerous head traumas. And by no means is his story clear cut.
What is clear, however, is that the charismatic Pinkerton Academy and Dean College student hid symptoms of the injuries he sustained at home and at school from coaches, trainers and doctors until it was too late.
“If Sean’s coaches knew how bad off he was, they wouldn’t have let him play,” Jack Foley said. “I would never buy a used car from him — he was deadly cute.”
Sean played soccer and baseball from an early age, but there wasn’t enough physical contact for his liking. When he was 9, he picked up lacrosse and participated on several local youth teams.
By the time he was a middle-schooler, he could hurl the ball 106 miles an hour from his stick’s pouch.
By all accounts, Sean was aggressive both on and off the field. Fist fights were the norm. Academics were a chore he didn’t care for at all, his father said.
Playing rough on the field helped channel a lot of his energy in a positive way that kept Sean out of a whole lot more trouble, his father said.
“If it hadn’t been for lacrosse, he would have been dead from drugs a lot sooner,” Jack Foley said.
Sean’s first concussion happened when he was thrown from a horse and kicked in the head by another at 11 years old. Luckily, he was wearing a helmet. The second concussion didn’t happen until his freshman year on the Pinkerton Academy football team in 1995.
“He hit someone else with his head, helmet-to-helmet,” Jack Foley said. “It was a clean hit — no cheap shot. But he came off the field and collapsed. I had to keep his mother from flying off into the sky.”
Sean insisted on being back on the field the next day. Insisted, his father said.
The third concussion came his sophomore year, when his car skidded on black ice and flipped along a winding, local road.
“He bounced on his head and a helicopter took him to Boston,” Jack Foley said. “I resisted, but we took him home that night. I wanted all sorts of tests done and I told the doctors about the other concussions, but they didn’t do an MRI or anything.”
After that, Foley noticed a marked shift in Sean’s personality. He went from a sweet kid who his father once caught crying in a movie theater to displaying “rancid” behavior, Jack Foley said.
His short-term memory was shot. He struggled in the lowest level classes and dropped out of school shortly after his junior year because his failing grades prevented him from playing lacrosse.
“He felt useless when he couldn’t play lacrosse,” Jack Foley said. “He was working at Wal-Mart. I remember one time after he got paid how upset he was that he only earned $400.”
The father remembers his own reaction. “I told him, ‘Get used to it. You don’t have anything to really offer anyone without an education.’”
Sean completed his GED and received an athletic scholarship to play lacrosse for Dean College, a two-year school in Southern Massachusetts. Ever the aggressor, he was hit in the head another three or four times, his father said.
When he finally sought medical attention for an incessant copper taste in his mouth, he was diagnosed with concussive brain syndrome. Medications helped keep seizures at bay, and Sean continued playing lacrosse.
After graduating from Dean, he enrolled at Catawba College in Salisbury, N.C. A misstep into an irrigation ditch during practice caused him to tear his knee, definitively ending his lacrosse and academic career.
Sean returned home to become a carpenter’s apprentice. He was depressed, his father said, and “rasing hell all over town” until May 26, 2005.
“I sat him down at this kitchen table and told him his mother had been diagnosed with terminal cancer,” Foley said, his voice quivering. “He got up, gave me a hug and a kiss and said, ‘I love you, dad.’ Then he went upstairs to shower.”
Later he went outside to start his Jeep, but he didn’t leave right away.
“(He) came back in and gave me a hug and a kiss and said, ‘I love you, dad,’” Jack Foley said. “And that was it.”
Around 2 a.m., local authorities told Jack Foley his son was in an ambulance, en route to the hospital.
“He probably was drinking and he probably was doing drugs. He had a seizure and that was the end of Sean,” Jack Foley said.
Foley, whose wife of 31 years died later that summer, now sleeps in Sean’s old room. His daughter Heidi lives with him.
Sean’s nephews, Christopher and Cody, use his old lacrosse sticks; Sean taught them to play years ago.
“He played 150 percent every game,” Foley said. “He couldn’t figure out another way to play.”
Nor could Foley find it in himself to hold Sean back.
“It was a great 25 years,” the father said. “ He wasn’t perfect, no. But I thought he was.”
No more hiding
Sean is far from the first athlete to hide his injuries from coaches and doctors. That’s why it is so important that coaches, athletic trainers and even the athletes be taught to recognize symptoms.
“I’ve had kids come up to me and say, ‘Mrs. St. Onge, go take a look at Johnny, something’s not right,’” said Andrea St. Onge, one of two certified athletic trainers on staff at Pinkerton Academy.
“We do a lot of education for our coaches and our kids,” she said. “They know it’s serious. There’s more information now than ever and they know it’s not considered just a ding anymore.”
St. Onge has researched various methods of testing for concussions, including the ImPACT Baseline Testing Program, the Standardized Assessment of Concussion, and the Balance Error Scoring System.
Pinkerton has yet to adopt any of the tests, St. Onge said, because of conflicting research. Instead, she conducts her own informal tests on the sidelines to assess the memory and balance of athletes she believes could be affected by a concussion.
Also, St. Onge said, any student who loses consciousness or has a repeat concussion is required by the school to see a doctor. And students must wait, on average at least a week, before easing back into activity.
Pinkerton’s policy is similar to that of most other local schools.
Nairi Melkonian, athletic trainer at the Brooks School in North Andover for 19 years, relies largely on ImPACT, a 20-minute neurological cognitive testing program, to detect and monitor concussions.
Last year, all players on the Brooks football, hockey and lacrosse teams took the computerized test at the onset of their seasons. This year, all players on the wrestling and basketball teams also will be tested.
ImPACT gathers data on each athlete’s normal response to visual and verbal memory questions as well as his or her reaction time. If the student suffers a concussion, he or she retakes the test and doesn’t play until the score returns to the pre-season baseline. A doctor is consulted, for a fee.
“What’s important is the reaction time to the questions,” Melkonian said.
Athletic trainers at Andover High School, Haverhill High School and Timberlane Regional High School use a free paper form, called the Standardized Assessment of Concussion, for students in high-contact sports.
The five-minute series of questions to assess an memory, concentration, neurological function and coordination is done at the beginning of the season for a baseline and on the sidelines of a game immediately following an accident, should one occur. It’s done again after several days to see if the student is ready to return to play, said Kate White, athletic trainer at Andover High School.
“Most coaches have been around a long time and are in it for the long haul,” said Dave Nicholas, co-athletic director and health director at Andover High School. “They’re not going to bet a lot for a little win. The coaches around here aren’t likely to jeopardize a kid’s heath to win the next game.”
Salem High School took part in concussion research about four years ago through the University of North Carolina at Chapel Hill. Since then, the school has used the Balance Error Scoring System, said Athletic Director Christopher Bergeron.
A series of 20-second tests, BESS measures how well an athlete can maintain balance while standing still in three different poses on both a firm and foam surface.
While all this testing helps cut down on the number of undiagnosed concussions, along with the risk of players returning to their sport too soon, most schools have only enough resources to assess a small portion of their athletes — and some schools don’t have the resources at all.
That means student athletes and their parents need to be proactive.
“Don’t let anyone tell you that a ding to the head or getting your bell rung is OK. It’s going to happen, so identify it and deal with it properly,” said Andrew Cannon, a board-certified sports physical therapist and director of sports medicine at Northeast Rehab Health Network.
“Parents need to be aware that this is a risk inherent in any sport and more so in collision sports,” Cannon said. “Don’t let anything your child says slip by. If the kid brings it up, they’re thinking about it. If the coach or athletic trainer won’t take it seriously, you need to move on to the next resource.”
Head injury warning signs
Head injuries are among the most serious threats for young athletes. Symptoms may be subtle, but when untreated, they can lead to serious results. Here are symptoms that may indicate brain injury. Athletes suspected of having an injury should be referred to a medical professional before returning to physical activity.
A coach notices an athlete:
r Appears dazed or stunned
r Is confused about assignments
r Forgets plays
r Is unsure of the game, score or opponent
r Moves clumsily
r Answers questions slowly
r Loses consciousness
r Changes behavior or personality
r Cannot recall events before the impact
An athlete complains of:
r Balance problems or dizziness
r Double vision or fuzzy vision
r Sensitivity to light or noise
r Sluggish feeling
r Foggy or groggy feeling
r Problems concentrating or remembering
Source: Centers for Disease Control and Prevention
Defend Your Brain!
What: Young Athlete Concussion Initiative. This three-part community education program on sport concussion in all youth through high school athletes, regardless of sport. Topics includes sport concussion causes, risks, prevention, identification, immediate and long-term care of the young athlete who sustains a concussion, and guidelines for return to participation.
Who: Intended audience includes young athletes, parents, coaches, officials and any members of the health-care team involved with youth and interscholastic athletics.
When: First in the series scheduled for Nov. 15
Where: Tentatively at Merrimack College, 315 Turnpike St., North Andover
How: For information, call 603-681-3570 or e-mail Jhogg@northeastrehab.com
Coach training requirements spotty from state to state
While many states require some form of head-injury education for school coaches, programs usually focus on helping athletes avoid injury, rather than how to react in the moment of an emergency.
Across the country, roughly half of the states require teachers to take courses in basic first aid or sports first aid before they become coaches; 34 states require first-aid classes for coaches who are not teachers.
Massachusetts and New Hampshire both require staff and non-staff coaches to receive sports first-aid training, according to a study by CNHI News Service. CNHI is the parent company of Eagle-Tribune Publishing Co.
Coaches usually meet these requirements by taking online courses from the American Sport Education Program or the National Federation of High School Associations.
Seven states — Arizona, Florida, Michigan, North Carolina, North Dakota, Pennsylvania and Virginia — have no training requirements at all, according to the CNHI study. Another 12 states require no additional training for teachers who become coaches. And only three states — Connecticut, Iowa and Wyoming — require specific training in sports injury prevention.
Locally, coaches at Pelham High School are trained in CPR and first aid. Coaches at Andover High School, also CPR trained, regularly review the school’s emergency plan, said David Nichols, the school’s co-athletic director and health director.
“We had a student last year who had a heart condition, and it was a good reminder for us,” Nichols said. “We reviewed all our emergency procedures: Can we access his physical information immediately? Can we call his doctor right away? We’re always updating a better communication system to improve how quickly we can respond.”
It’s critical that coaches know CPR, he said, because they often are first on the scene. But certified athletic trainers assume much of the responsibility for addressing injuries, whether they’re one-time incidents or ongoing issues. This way, coaches can concentrate on coaching.
“We should train coaches in basic red light, yellow light, green light injury education,” said Andrew Cannon, a sports physical therapist and director of sports medicine at Northeast Rehabilitation Health Network, “but we shouldn’t expect the coaches to be making the decisions regarding an athlete’s health.”
Many local public and private schools, like Brooks School in Andover, have a full-time certified athletic trainer on staff. Both Salem High School and Haverhill High School contract a part-time athletic trainer in addition to having a full-time athletic trainer on staff.
Other schools, like Central Catholic High School in Lawrence, are trying to increase coverage from contracting a certified athletic trainer for approximately 20 hours of practice and game coverage each season to eventually budgeting for a full-time staff member.
“For a lot of schools, it comes down to a budgetary issue,” said Peter Paladino, the school’s athletic director. “I’m trying to impress upon folks that we need to employ our own athletic trainer, so we’re not at the mercy of a contractor.”
CNHI News Service reporter Randy Griffith and Eagle-Tribune staff writer Emily Young contributed to this article.
Training requirements for high school coaches
Here is a sampling of national youth sports groups and what, if any, training they ask of their coaches.
r Babe Ruth and
Cal Ripken Leagues
What: Baseball, softball
Ages: 4 through 18
Players: Almost 1 million
Coaches training: Coaches must complete a 10-unit online course by July 31, 2008. A “safety and fitness” segment deals with injury prevention.
Headquarters: Trenton, N.J.
r Pop Warner
What: Football, cheerleading
Ages: 5 through 16
Coaches training: Beginning next year, coaches are required to take a one-day workshop, which includes some lessons on health and safety.
Headquarters: Langhorne, Pa.
r US Youth Soccer
Divisions: Under 5 through 19
Players: 3.2 million
Coaches training: No national requirements, though the group offers an extensive licensing program that covers injury prevention, conditioning and safety. More than half the state organizations require coaches to be licensed.
Headquarters: Frisco, Texas
r Little League
What: Baseball, softball
Ages: 5 to 18
Players: About 2.7 million
Training requirements for coaches: None
Headquarters: Williamsport, Pa.
r Amateur Athletics Union
What: Nearly 40 sports from basketball to table tennis
Ages: Children and adults. Rules vary depending on team and event.
Players: More than 500,000
Training requirements for coaches: None
Headquarters: Lake Buena Vista, Fla.
— Compiled by Randy Griffith,
CNHI News Service
Hot training topics
Dave Warwick, a contract athletic trainer at Haverhill High School, finds new safety and health issues to focus on every year.
This year, it’s high-energy drinks, which he is banning because their high levels of caffeine can lead to dehydration.
Warwick is hot on preventing methicillin-resistant Staphylococcus aureus, a staph infection that has become resistant to the vast majority of readily available antibiotics. MRSA is an aggressive skin infection that can easily be transmitted in locker rooms or through high-contact sports like wrestling, said Dr. Edward Bailey, chief of pediatrics at North Shore Children’s Hospital in Salem, Mass.
“So now everyone has to shower after practice and after games,” Warwick said. “We’ve got soap around that kills this stuff. I used to have kids leave their uniforms in their locker and their goal was not to wash it for the season. Not anymore. They need to wash their helmets, their pads, every week.”
Warwick says injuries can often run in packs. Five years ago, he saw a trend in pulled hamstrings. In response, he helped the coaches modify stretching routines. Hamstring pulls all but disappeared.
“The coaches are respectful of what I do,” Warwick said. “Over the years, coaches have become more aware of a trainer’s role. We don’t just throw tape on somebody. We rehab it in sessions over time to get them ready for drills, practice, and then games.”
— Emily Young
Head injuries bring family ultimate loss