What should have been a routine trip to the store and dinner last October turned into a multi-month nightmare for Bella Raytick. She accidentally hit her head on the car door when she opened it. By the time Bella and her mother, Ann Casapulla, reached the store, the signs of a concussion were already evident.
“Instantly I had a headache, and my eyes hurt,” Bella said. “When we got to Staples, it’s so bright in there, it hurt my head so bad.”
Bella, then in seventh grade at All Saints Catholic School in Elsmere, got through dinner, but she couldn’t think straight or complete simple tasks. She went to school the next day, which was Halloween. That proved to be a mistake.
“I had a bruise on my head,” Bella said. “Everyone thought I put that on there for Halloween. We went to watch a Halloween movie, and I looked at the SMART Board, but I couldn’t concentrate. Following the pictures, it hurt my eyes.”
Bella was diagnosed with a concussion. Her recovery included staying out of school for three weeks, then attending part-time with restricted academic activity until a week after students returned from Christmas break. She missed another few days after hitting her head again, but eventually was cleared for academic and athletic activities.
Fortunately for Bella, All Saints has been baseline concussion testing its sixth-through eighth-grade students for two years, providing healthcare providers a critical tool to help measure progress in recovery.
Bella’s baseline testing before her head injury played a role in when she was able to return to school, begin taking exams and, finally, resume all normal class activities.
Diocesan pilot program
Now, thanks to a pilot program that starting this year in diocesan schools, the same baseline information will be available for every sixth- and ninth-grade student.
In addition, every child who is playing football for a Catholic Youth Ministry team, regardless of where he or she attends school, is being given the opportunity for baseline testing under the same program, said Joe McNesby, director of CYM athletics.
The testing is being made possible by a grant from Dynamic Physical Therapy, a rehabilitation provider.
The program, which will be implemented over the course of the school year, may be a first for Delaware. Most schools test and follow concussion protocols for athletes, but blanket testing by an entire district — thinking of diocesan schools that way — for an entire grade is rare.
Each year, sixth- and ninth-graders will be tested, so within four years, every Catholic school student in sixth- through 12th grade will have a baseline test on file that includes a student’s pre-injury learning and memory abilities, concentration and problem-solving skills.
Not just athletes
That’s good news to Dr. Vince Schaller of Premier Urgent Care Center in Kennett Square, Pa., and a founder of the Mid-Atlantic Concussion Alliance. Although the focus on concussions has centered on athletes, there are a number of causes of brain trauma, such as Bella’s encounter with the car door.
“In my clinic, I’ve had so many people in car accidents who are kids, fallen on ice, fell with their tuba during band in high school. I’ve had kids fall down the stairs at school,” Dr. Schaller said. “You don’t have to be an athlete playing for the CYM or the school to get a concussion. It’s silly to keep focusing on the athletes because in reality life has concussions.”
Under the program, all sixth- and ninth-graders whose parents sign a consent form will be tested. The results will be available online to any hospital, clinic, physical therapy center or doctor who is a member of the M.A.C. Alliance. That way, the baselines will be available on nights and weekends, when many sports-related concussions occur, and if a provider is not a member of the alliance, a parent will have access to the information.
The program was introduced to principals in the diocese in mid-August by Angel Boyce, a nurse practitioner with the M.A.C. Alliance. She said awareness of concussions is filtering down, from professional and college athletics to children in elementary school.
An invisible injury
Changing the way people think about head trauma is not easy, but it is critical.
“What we’re talking about is a culture shift and an idea that says we have to think about this differently,” Boyce said. “We’re now finding evidence that says there may be an impact to this long-term, whether it’s early Alzheimer’s, dementia or early onset of disease processes that would go longer in age.”
She said part of the problem in developing awareness is because, unlike a broken arm, one cannot see a concussion. But the damage can be much more long-lasting.
“If you think about a concussion, a concussion directly impacts a child’s ability to learn,” she said.
Schaller, who has worked with diocesan schools for about 10 years, said the lack of access to baselines prompted him to launch the M.A.C. Alliance. Currently, more than 60 schools are members.
Students, primarily athletes, would come to his previous clinic in Hockessin. He would ask for their baseline results and on many occasions found that the schools did not have a centralized database. Oftentimes, only athletic trainers had access to the results, and many arrived at the schools after working a full-time job during the day. The results would need to be printed and faxed to his office. A lot of times, the timing was not beneficial, either.
“So what ended up happening was, most of my players I’d see on a Friday night, Saturday morning from football games, over the weekend, soccer and all, and I’d be seeing these kids with no baselines. And I’d be thinking, ‘I really need to get access to these tests,’” he said.
Peace of mind
The program has worked well at All Saints, which currently tests all students in sixth- through eighth-grade. It has never been an issue with the parents, principal Diana Thompson said. “They’re very happy it’s being done.”
Richard Hart, the principal at St. John the Beloved School, said the testing is a great service to the parents and school and offers them peace of mind.
“We can develop an education plan for (students) to help them with the academics” based on post-concussion test results and doctors’ recommendations, he said.
That was what All Saints did for Bella, her mother said. For a while, Bella couldn’t go to music or phys-ed class, and she couldn’t look at a SMARTBoard, which emits a lot of light. Some days she was affected by things that on other days would not bother her.
“Her mind needed to relax. She would go to the nurse just to sit down in the quiet,” Casapulla said.
Although the rollout is being left up to each individual school, most of the baseline testing will take place during a class period. There will be no cost to parents, as sponsors have offered to pick up the cost for sixth-graders and high school freshmen, Schaller said. If schools want to test other grades, the cost through the M.A.C. Alliance is nominal.
Schaller grew up attending Catholic schools and saw his parents volunteer when work needed to be done. He, in turn, offered his services to the Diocese of Wilmington’s schools and has been able to provide each one with a nebulizer and albuterol and other medications.
Guidance for teachers
The program will require some adjusting, said Dana Delle Donne, co-principal of St. Elizabeth Elementary School. Teachers will have to adapt to a student who is not able to take notes or a test, or who is sensitive to light or sound. She would like to see guidance on how teachers should handle a case.
“You may be able to read them a test. You really need to just follow the doctor’s recommendations. That’s where it’s important that the teacher reads everything that comes from the nurse,” she said.
Delle Donne is a veteran volleyball referee in Delaware and is required to undergo training every two years to make sure she knows the signs of concussion. Sometimes these can be missed or overlooked – for example, by a student who is used to performing on the field or in the classroom – and the baseline test results will give everyone involved an objective reading of how far along the student is in his or her recovery.
“They can see where it is and where it stands, and I think it gives the parents that are pushing them to get back involved a real concrete example that they’re not ready,” Delle Donne said.
Not only the parents, but the students themselves, Casapulla said. “When (Bella) had to totally relax, all she worried about was how much she was missing. That’s kind of hard to deal with as a parent.”
Bella, who plays volleyball at All Saints, is back at school with no restrictions, although she still suffers the occasional headache and dizziness. She encourages all students to take advantage of the testing. “I think it’s really important. I didn’t know how bad it was until I took the test.”