Logo for University of Iowa Health Care This logo represents the University of Iowa Health Care

Dr. Mark Granner discusses concussions in Gazette article

Concussions more than a headache for athletes, students

HS journalism: A look into the diagnosis, damage and treatment

By Ellie Gretter, I.C. West senior and Deniz Ince, I.C. West junior
Dec 12, 2017 at 2:13 pm

IOWA CITY — Most students and athletes know the common symptoms of a concussion: headache, dizziness, confusion, What many don’t know are the feelings of debilitation and darkness experienced.

Iowa City West senior Ella Gibson said she “fell to the ground and just sat there for a second when everything was just dark” after suffering a concussion, and sophomore Makhi Halvorsen described a similar experience. Gibson, however, continued to cheer while Halvorsen sat out for the rest of his football practice.

Junior Grace Miler illustrated lesser-grade symptoms when she first suffered a concussion, but reflecting on the injury made her change her opinion of it.

“I did not (pass out), I stayed standing up and I was able to kind of comprehend what was happening, but I could not see very well,” she said. “It made me realize how easy it is to get a concussion and how much it can affect you. When I used to hear that people got a concussion I thought that they just had a headache, but no. It hurts really bad, and it is something pretty serious.”

After an athlete has suffered a concussion, there is a strict protocol that must be followed to lessen any further damages. The protocol begins 24 hours after the symptoms have completely dissipated. The two protocols most prevalent at West are the REAP and SCAT 5 test.

“The REAP protocol is the concussion management for the education side of recovery,” West athletics trainer Sheila Stiles said. “The protocol stands for remove/reduce, educate, adjust/accommodate or pace. So, it is reducing the amount school work that piles up after a concussion when a kid misses school, allowing them rest time while they are returning from a concussion.”

The SCAT 5 is the most common test used to diagnose a concussion on the sidelines. But, the SCAT 5 is a lot more effective if there is a neurocognitive baseline to compare. This can be done by the athletics trainer and does not require a doctor to diagnose or treat an athlete, according to pediatric sports medicine specialist Andrew Peterson.

“I don’t mind being the one to manage the concussion but also if someone is really having some lingering symptoms or really struggling and I can’t get a handle on it that’s when I really try to push for (University of Iowa Sports Medicine) for the Concussion Clinic,” Stiles said.

Not only was the effect of a concussion immediate on these athletes’ ability to practice and compete, it also affected them in the classroom. At first, Halvorsen did not take a concussion test or know the culprit of his symptoms. This led to a drop in his ability to perform well in class.

“It was kind of hard remembering stuff for school, but it’s slowly starting to come back,” he said roughly two weeks after first diagnosed. “My grades most definitely dropped for a little bit because (I) didn’t really know what was happening.”

Now, teachers are emailed to fill them in on the brain injury their student is experiencing. Just as athletes undergo a “return to play” protocol, the cognitive delays may promote a similar “return to learning” time period, which usually is within three weeks, according the American Academy of Pediatrics.

“‘Return to learn’ is the concept behind (students returning to school),” said Mark Granner, a clinical professor of neurology and director of the Neurology outpatient clinic at the University of Iowa Carver College of Medicine. “It’s not something that coaches and trainers only have to know about, it’s something that teachers have to broadly be aware of, too.”

The time effects stay prevalent in the brain vary widely based on the person. Peterson said the “average duration of symptoms is eight days. Our best data is in high school boys where 95 percent of people are healed by the one-month mark and 99.5 percent of people are healed by the six-month mark.”

At West High, athletes can expect to be sitting out for at least five days following diagnosis. This is because it will take this long to go through protocol to be ready to compete. But for many it takes longer. Stiles said on average, athletes will not practice for “a week to two weeks. But there’s definitely those cases that are a lot longer and there’s those cases that are right at the five days.”



Before the start of the season, seven teams participate in ImPACT testing — football, girls’ and boys’ basketball, wrestling and girls’ and boys’ soccer.

This test is performed to get a baseline for an athlete who suffers a concussion during their season.

“It’s based solely on their performance alone it’s not compared to anybody else,” Stiles said. “If their scores are similar or better to the scores they took at the baseline then we know their brain is most likely ready to return to activity.”

This year, the volleyball team was added to the list that take the test. This baseline has become almost vital to diagnosing and recovering from concussions since there has never been a quantifiable method available before.

“Concussions are diagnosed by signs and symptoms,” Stile said. “It’s not something that you can take an MRI scan of. It goes by what do we see as the medical professionals and what people report to us on how they’re feeling after a traumatic brain incident.

“So, the test gives us tangible data to go off how the kid is progressing or not progressing and how they feel immediately after having an episode.”

Gibson believes she received lesser quality treatment because cheerleading does not participate in ImPACT testing.

“I mean it felt a little different just because there wasn’t much structure to how I went through things,” she said. “I’d heard from all my friends (on the football team) they do testing before the season even starts to compare it to if they get (a concussion) during the season. So, there’s nothing to compare my scores to. It’s all based on how I feel and so I was just basically going off nothing.”

Since the number of concussions has increased, Stiles believes ImPACT testing should be extended to the cheerleading team.

“The research is showing a high incidence of concussions in the sport of cheerleading and especially when we have the competitive cheer to where they’re doing more tumbling,” Stiles said.

Although ImPACT Testing is a positive step to finally solving the mystery of concussions, there also are some drawbacks to using this test.

“The ImPACT (test) is a double-edged sword,” Stiles said. “You can do really well on your baseline and then never get back to that.”



The global cerebral dysfunction can cause several other parts of a brain to be injured, according to Peterson

“Your brain sits inside your skull in some fluid. When you hit your head, your brain can slam against the skull where it hit or it could also go backward like (a) whiplash effect,” Stiles said. “Or there can also be some sort of shearing, like spinning.”

As the control center for the body, it can cause numerous other organs to malfunction, especially those located near the head and neck.

“Your occipital lobe is in the very back and that controls your eyes,” Stiles said. “So that’s where you might see double vision problems in general and the light bothering you.”

This makes it more common for athletes to experience blackouts and issues pertaining to vision upon injury.

“I just felt really slow and I blacked out, which kind of scared me because I kind of lost my breath and came back,” Halvorsen said. “Everything was darker.”



Despite knowing the dangers of concussions, Granner allowed his son, West senior Alex Granner, to play football in sixth grade.

“We considered it pretty carefully,” Mark Granner said. “We understood there was risk of traumatic brain injury, including concussion risk. In fact, one of the kids he played basketball with at that time had already had a concussion earlier in fifth grade when he was playing tackle football.

“I think behind the scenes, his mom and I, were hoping he didn’t really go farther than that and that’s what ended up happening.”

In line with his parents’ beliefs, Alex decided after one year he did not enjoy the sport and he stopped playing.

“They sort of steered me away from it because it’s not the best sport to play long-term,” he said. “I didn’t like it either because ... I only touched the ball like once per game.”

Although Mark Granner did not want his son to play the sport, he has held season tickets to Iowa football for 25 years.

“I cringe when I see players getting hit with the ball,” he said. “I cringe when I see them going down on the turf.

“It’s tough, knowing what the risks are to the brain and the nervous system. It’s a little bit conflicting.”



Since chronic traumatic encephalopathy (CTE) was discovered in the early 2000s, knowledge on the subject has slowly begun to accumulate. However, it was not until the movie “Concussion” was released in late 2015 that the public began to worry about the condition.

Though it has been known for more than a decade, there still are comparatively little known facts about CTE. Additionally, most of the research has been done on the brains of former professional football and hockey players and does not include many age groups and athletes.

“The brains that have been examined so far are people who’ve played professional football, but every professional football player played high school football and played college football, too, so it’s really not known if there’s a certain risk window or if stopping at a certain age reduces your risk or not,” Granner said.

The lack of evidence in the correlation between this condition and high school athletics may resolve in coming years, but for now students look to their diagnoses as signs of whether to continue participation in their sport.

“It also made me a lot more cautious about high school cheer and how unsafe it is, because in all my three years of cheering no one has ever gotten injured (as much),” Gibson said. “It’s been the first two months (and I have had) head-neck injuries, which shouldn’t be happening so that makes me a little nervous with it.”

Halvorsen, having never suffered a serious injury from football, was taken off guard when he was diagnosed with a concussion. When he returned to the field, he took safety into account when tackling.

“Now I’m just a little more cautious,” he said. “I’m a little more safe with the way I hit people, because I didn’t like having a concussion, so I don’t want to give someone (one) even if it’s an accident.”

Even before diagnosis, Halvorsen clashed with his mother on their opinions of football.

“She always tells me that later on in life people are just going to stop playing because they’re going to realize how bad of a sport it is because of injuries but it’s not going to stop me,” he said. “Personally I feel safe enough because it wasn’t a huge concussion. I feel like maybe if it was my second concussion or third then maybe I’d be more scared about it, might take a break for a year or something like that, (but) I feel like it’s very hard to get one. You don’t just get one from a little hit; it takes a big hit to get one.”

While having experienced this risk, Halvorsen still has a passion for the sport, driving him to keep playing after having experienced the head trauma.

“It’s my favorite thing to do,” he said. “I’m just going to keep going until I’m going to have to stop at some point but I’m just going to keep going.”

Granner, as a parent having experienced his son playing football, believes the athlete, or the parents, ultimately will decide the fate of high-concussion sports.

“It’s impossible to make football a completely safe sport, but the reality is soccer isn’t a safe sport, or basketball isn’t completely a safe sport, either,” he said. “If the sport faces an uncertain future, in my opinion, it’s going to be in the hands of parents who either let their kids play or not.”

Wednesday, December 13, 2017